Study: Specialized approach needed for infant head injuries
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Key takeaways:
- Among children evaluated for head injuries, infants aged younger than 3 months have higher rates of traumatic brain injury than older toddlers.
- The youngest infants also have higher rates of admission and death.
Among children aged younger than 2 years evaluated in the ED for a head injury, infants aged younger than age 3 months were far more likely to have a traumatic brain injury than older toddlers, a study found.
They also were more likely than older toddlers to undergo cranial imaging, have a clinically important traumatic brain injury (TBI), be admitted to the hospital and die.
Researchers said the results show that a more specialized approach is needed to address head injuries in young infants in order to minimize harm.
“We're challenged with really figuring out what to do with these young babies who are challenging to examine who might be the victims of abusive head trauma,” Todd W. Lyons, MD, MPH, an emergency medicine physician at Boston Children’s Hospital and assistant professor of pediatrics and emergency medicine at Harvard Medical School, told Healio.
Lyons and colleagues conducted a retrospective, cross-sectional study of data from 47 hospital EDs in the Pediatric Health Information Systems database, identifying children aged younger than 2 years with a diagnosis of a head injury and applying exclusion criteria to focus on isolated head injuries.
For outcomes, they measured rates of imaging, brain injury, clinically important TBI, hospitalization and death and compared them among different ages.
The researchers identified 112,885 ED visits for children aged younger than 2 years with isolated head injuries, 9.1% of which occurred among infants younger than age 3 months.
Compared with children aged 12 to 23 months old, the youngest infants were significantly more likely to undergo any diagnostic cranial imaging (50.3% vs. 18.3%), be diagnosed with a TBI (17.5% vs. 2.7%) or clinically important TBI (4.6% vs. 0.5%) and to die (0.3% vs 0.1%).
Among those undergoing CT or MRI, TBIs were significantly more common among the youngest infants (26.4% vs. 8.8%).
“The finding that the young infants were imaged at a higher rate really wasn't surprising to us, necessarily, but the rate of 50.3% was surprising to most of us,” Lyons said. “With that said, this rate really appeared to be supported by the higher rates of findings in this age group.”
Given the high rates of imaging and risks of radiation from MRI, Lyons said he would be interested in future research focused on the safety and cost-effectiveness of protocols that use rapid MRI.
“Ideally, we look at developing a radiation-sparing protocol that doesn't miss injuries that's cost effective, and that reduces the overall radiation exposure for these young infants who are a particularly vulnerable population,” Lyons said.
In an accompanying editorial, Audrey Raut, MD, and Mary Clyde Pierce, MD, both of the Northwestern University Feinberg School of Medicine, noted that MRI remains inferior to CT scan for skull fracture detection.
“However, in cases of skull fractures resulting from physical abuse, a social intervention improving that child’s environment could make a significant difference in their trajectory of recovery,” they wrote. “Regarding whom to image and which modality to use, advances in science have the potential to dramatically change this risk–benefit analysis in the future. For now, however, radiation seems to be worth the risk.”
References:
Lyons TW, et al. Pediatrics. 2024;doi:10.1542/peds.2023-065037.
Raut A, et al. Pediatrics. 2024;doi:10.1542/peds.2023-065511.
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