Management of Head Injuries in Under 2s: Assessing the Implementation of a Clinical Guideline during the Covid-19 Pandemic

Background: Head injury is a common presentation to the Paediatric Emergency Department (PED). Responding to the Covid-19 pandemic, practice guidelines in University Hospital Limerick changed so that children under 2 years were assessed directly by the Paediatric Medical Emergency Team, reflecting the NICE head injury assessment guidelines.

Objective: To determine the prevalence of head injury presentations in the under 2s cohort to the PED between April and June 2020 and to compare this with the same period in 2019. To assess admission rates, the number of neuroimaging studies, and the significance of the newly implemented guideline.

Methods: A retrospective audit of presentations of head injury (

Results: Between April-July 2020, there were 53 presentations with a total of 21 admissions (39.6%), and 4 (7.5%) requiring neuroimaging. Frequency of admission by age was as follows; 0-6 months (100%), 6-12 months (66.6%), 12-18 months (20%), 18-24 months (9%). In 2019 there were 46 presentations, 4 admissions (8.7%) and 1 requiring neuroimaging (2.17%). Admissions by age group were as follows: 0-6 months (50%), 6-12 months (0%), 12-18 months (25%), 18-24 months (25%).

Conclusion: We have shown that the change in service provision for PED during the Covid-19 pandemic has increased our rates of admission, due to the introduction of a local guideline for head injuries under 2 years, in keeping with NICE Guidelines. We feel that this has improved patient safety and reduced risk of adverse events. The care of patients under Paediatrics vs Surgical Teams prior to Covid-19 must also be considered as an influencing factor.