소아 두부외상의 임상적 고찰 = PEDIATRIC HEAD INJURY: THE NATURE, CLINICAL COURSE, AND OUTCOME

다국어 초록 (Multilingual Abstract)

Head injuries are a major cause of emergency department visits among the pediatric age group, frequently require extensive treatment and often result in disability or death. It has been reported that accidents cause more than half of all children death. And despite the early diagnosis and proper treatment head injury is the most common cause of death in children aged 1 to 15 years, accounting for 15% of death in this age group. In addition, the studies about pathophysiology of craniocerebral trauma indicate that the symptomatology and threshold for neurophysiologic dysfunction are different in children and adults.
This report examined the nature of head injury, clinical course and the outcome of pediatric cases ranged from birth to 15 years at the Department of Emergency Medicine, Chung Ag Gil Hospital for 1993(N=900).
The age incidence was greatest in 6∼10years(44.1%) and the spring was the most common season in which the head trauma occured. Traffic accident(47.0%) and fall (36.9%) were common as a cause of head injury. The distribution of Glasgow coma scales(GCS) was : 10.0% of children GCS 3∼8, 11.1% GCS 9∼12, and 78.9% GCS 13∼15. Concussion was diagnosed in 60.2% and skull fracture without intracranial abnormality in 14.8%. The frequency of mass lesion with or without skull fracture was 21.2% and diffuse brain injury was 3.8%.
In clinical course 38.4% experienced loss of consciousness, 54.3% vomiting and 6.3% early post-traumatic convulsion but late epilepsy was not developed at all during the 6 months' follow-up period. Of 224 cases of intracranial abnormality, lucid interval was observed in 15.2%. Among 299 cases that showed a kind of skull fracture, associated intracranial lesion was detected in 55.2%. Besides of head trauma, 33.8% had associated injury and of which sprain was the most common type. As a whole neurosurgical interventions were required in 163 cases(18.1%) and in detail 18.7% of skull fracture, 72.6% of mass lesion. According to the GCS, 6.9% of GCS 13∼15 needed surgery, 55.0% of GCS 9∼12 and 65.6% of GCS 3∼8.
In the outcome, the higher scored cases on the GCS were better than the lower scored ones. The overall mortality rate was 2.4% with the highest rate at GCS range of 3∼8, subdural hematoma among the mass lesion and aged from birth to 5 years.