Mild Head Trauma in the Pediatric Population under the age of 2: Who and How Many Patients in Real Life Access the Emergency Department?

Background: In the United States, ten out of every 100,000 children die each year from head trauma. This pathology therefore represents one of the most frequent aspects of the activity of a ED.

Objective: Describe the pediatric population under 2 years of age who come to the emergency room for mild head injury in real life in a trauma center with 24-hour neurosurgery and neuroradiology service.

Methods: We enrolled patients aged <2 years who are consecutively referred to our emergency room from January 1st to December 31st 2018.

Results: We enrolled 250 patients under 2 years of age. 88.4% came from domestic accidents. 98.4% accessed the medical examination with a low priority code and required low intensity of care, 1.6% required high priority to the medical examination and the overall 0.4% required medium or high intensity of care. 95.2% were discharged and only 2.4% were hospitalized for observation in pediatrics. The remaining 2.4% preferred home observation despite medical recommendations. Only 0.8% of patients had a high (yellow or red) severity code at discharge. The average waiting times for the medical examination were 30 minutes with a median of 22 minutes. The overall hospital stay in the emergency room was on average 118 minutes with a median of 105 minutes. 2.8% of patients had a re-visit within the next day and a complex of 3.6% within 5 days. None of the patients had complications due to the fall at follow-up. Radiological requests with this protocol remained under 1% of accesses, without any subsequent serious complications.

Conclusion: The pediatric population under the age of 2 that comes to the emergency room for mild head injury only in a low percentage, less than 2 %, requires hospitalization and medium or high intensity of care.