[Characteristics of head trauma in children: epidemiology and a 5-year follow-up].

BACKGROUND Accidents are the major cause of morbidity and mortality in children. The aim of this population-based study was to describe characteristics of head injuries leading to hospitalization in children less than 15 years old, in a defined geographic population (Aquitaine: 2.7 millions inhabitants) and the longterm outcome (5-year follow up) of a sample of these patients. PATIENTS AND METHODS Hospitalized patients, residents of the region, were included in a prospective study during 13 weeks spread over the whole year in 1986 in all emergency services of the region. The follow-up study concerned patients hospitalized in 3 hospitals (a trauma I level center, a pediatric hospital and a general hospital), with a sampling frame taking into account the overall injury severity. Impairments, disabilities and handicaps were assessed with a structured questionnaire five years later and results in children compared with those of adults. RESULT Annual incidence of hospitalized head injuries in children was 294/100,000 inhabitants. The lethality was 0.3% in hospitalized patients. Ninety-two percent of head injuries were minor. In the youngest patients, the most frequent circumstances were a fall at home. The traffic accidents rate increased with age from 14% to 53% in the 10-14 years old children. Five years later, 104 children were reviewed (83 minor and 21 moderate or severe head injuries). Children complained less often of somatic symptoms than adults. Two children had disabilities in daily life activities, including one whose minor head injury eventually worsened and one after a very severe brain injury. According to the Glasgow Outcome Scale three patients had a poor recovery (2 severe and 1 moderate disability). CONCLUSIONS Origin and mechanisms of head injuries in childhood were similar than in previous studies. Incidence was higher because of a higher proportion of minor head injuries. Disabilities and poor recovery happened in children with brain lesions or in one children with a minor head injury complicated by a severe anoxia. Anxiety and depression should be better studied in these children.