"Start Early, Reach Safely" Avoid Road Traffic Injury.... Dr. Shailendra Anjankar DNB Neurosurgery India.

1. Pediatric head injury in last 7 years:
a hospital based epidemiological
analysis from Andhra Pradesh
Dr. Shailendra Deepak Anjankar

2. Title: Pediatric head injury in last 7 years: a
hospital based epidemiological analysis from
Andhra Pradesh
Author : Dr. Shailendra Anjankar,
Guides: Dr. Subodh Raju, Dr. M. A. Jaleel,
Dr. Dilnavaz B.
Department of Neurosurgery, Kamineni Hospital,
L. B. Nagar, Hyderabad, A.P., India.

3. Outline
Introduction
Aim
Material and Methods
Results
Discussion
Conclusion

4. Which is a safer place?

5. THE WORLD IS FULL OF IDIOTS ! THINK FIRST AND FAST

6. Introduction
 Population of India
(as on July 2011) :
1,205,073,612
 In India, children
between 1 to 14 years
forms 29.7% of total
population
Reference: Thomas M.McDevitt and
Reference: CIA world factbook. Patricia M. Rowe, The United States in
(Government organisation) International Context: 2000, Census 2000
Brief, C2KBR/01-11. U.S. Census Bureau,
Washington, DC. (2002), p. 9.

7. The statistics from India are
chilling!
At least 14 deaths per hour in 2008.
The total annual deaths due to road accidents
has crossed 1.18 lakh
Of total road accident deaths in the country
maximum are from Andhra Pradesh (12%),
Maharashtra (11%) and Tamil Nadu (10.8%).
The death rate per 10,000 vehicles in India is
45 while it is only 3 in developed countries.
Reference : National Crime Records Bureau (NCRB), 2008 report.

10. Leading causes of death, WHO 2004
2004 2030
Rank Disease or Injury Rank Disease or Injury
1 Ischaemic heart disease 1 Ischaemic heart disease
2 Cerebrovascular disease 2 Cerebrovascular disease
3 Lower respiratory infections 3 COPD
4 COPD 4 Lower respiratory infections
5 Diarrhoeal diseases 5 Road traffic injuries
6 HIV/AIDS 6 Trachea, bronchus, lung cancer
7 Tuberculosis 7 Diabetes mellitus
8 Trachea, bronchus, lung cancer 8 Hypertensive heart disease
9 Road traffic injuries 9 Stomach cancer
10 Prematurity & low-birth weight 10 HIV/AIDS

11. Reference : Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the
United States: emergency department visits, hospitalizations, and deaths. Atlanta
(GA): Centers for Disease Control and Prevention, National Center for Injury
Prevention and Control; 2010.
Reference : Luerssen TG, Klauber MR, Marshall LF. Outcome from head injury related
to patient's age.A longitudinal prospective study of adult and pediatric head injury. J
Neurosurg. 1988;68:409–16.

12. Children are not little adult!
Children have greater disposition to head trauma:
o Greater head mass relative to body weight ratio making
them top-heavy
 Neck musculature has not been developed to handle
relatively heavier structure
 Increased head weight results in increased momentum
during falls or injuries
o Brain area has more fluid: more susceptible to wave-
like forces
o Less myelination
o

13. The Aim of this study:
is to analyze epidemiology of Pediatric head
injury with respect to Mode of accident,
Pediatric Trauma Score, GCS, Radiological and
laboratory analysis and its correlation with
GOS.

14. Material and methods
In this retrospective study, we included all
patients with TBI aged less than 12 years
admitted in our hospital, during last 7 year.
Our hospital is 350 bedded Tertiary care centre
on National Highway (NH-9).
Patients admitted were examined and scored
according to Glasgow coma scale(GCS) score on
arrival and underwent computed cerebral
tomography (CT) scan, X-ray Cervical-spine as
routine protocol, as soon as feasible.

15. The patients medical files were
retrospectively reviewed, and
the data was collected and
was recorded in Proforma.
Age, gender, vital signs,
socioeconomic status, mode
of injury, GCS score, pupil
response, motor deficit,
presence of LOC, vomiting,
convulsion, ENT bleed,
Peadiatric Trauma Score, Brain
CT-scan and X-ray C-spine
findings, Lab investigations,
use of mechanical ventilation,
number of ICU stay, need for
surgery, and outcome
analysed at discharge and
follow-up.

18. Collected data were analyzed using Microsoft Assess
software and results were tabulated and compared.
Statistical tools – averages and percentages.

19. Results
During the study period, 209 children were
admitted with TBI in our hospital were included
in the study.
There were only 4 (1.91%) infants,86 (41.15%)
were belonging to age group of 1-5 Yrs and 119
(56.94%) were of 6-12 Yrs. Majority 142
(67.94%)were boys and 67 (32.06%) were girls.

20. The major cause of head trauma was Road Traffic
Accident (59.81%) which included
26.32% (55) RTA while Crossing the Road,
15.79 % (33) while traveling on 2 wheeler as pillion rider
7.66 % (16) while driving 2 wheeler,
10.05 % (21) while traveling in 4 wheeler.

22. Second most common cause of head injury
was fall from height (21.53%), whereas 4.78%
had injury due to fall of TV set on head.

23. Mean Glasgow Coma Scale was 12+/- 3,
116 (63%) had mild head injury,
68 (25%) had moderate head injury and
25 children (12%) had severe head injury.

24. 15.78% (33 children) presented with seizures
Most common was Loss of consciousness in 74.64
% (156 children) whereas Vomiting was present in
47.84% ( 100 children)

25. The median pediatric trauma score was 7.
Uni-variate analysis showed showed poor outcome
(GOS 1,2 and 3) in 80% (N=8) with PTS of < 0.

26. Bad outcome
Good outcome
(GOS 1,2,3) in 8/10
(GOS 4,5) in 2/10
GOS
PTS of
<0

27. Most common CT scan brain finding was fractures
seen in 86 (40.67%) children.
63 (29.67%) children had normal CT brain finding.

28. None of the children were found to have
associated cervical spine injury in our study
11% (23 children) required surgery for
traumatic brain injury in our study.

29. Mean serum sodium
was 137 +/-5, potassium
4.1 +/-0.6, hemoglobin
was 10.4 +/- 1.7.
Laboratory Mean value +/- 2 SD
parameters
Blood Glucose ( mg/dl) 128 --
Serum Sodium (mEq/ L) 137 5
Serum Potassium 4.1 0.6
(mEq/L)
Hemoglobin (%) 10.4 1.7

30. Mean blood sugar level was 128.37 and high
blood sugar level was found to be associated
with poor GCS at the time of admission

31. Glasgow outcome scale was performed at
discharge showed good outcome (GOS=5) for
(87.08% ) 182 children.
There were only 6 (2.87%) mortalities observed
in our study.

32. Discussion
Our study showed RTA as major cause of
pediatric TBI, whereas other studies from India
showed Fall as the most common cause.1-6
Majority of study including ours shows male
predominance.1-4
Reference:
1. Mahapatra AK. Head injury in children. In: Mahapatra AK, Kamal R, editors. A Text
Book of head Injury. Delhi: Modern Publ; 2004. pp. 156–70
2. Osmond MH, Brennan-Barnes M, Shephard AL. A 4- year review of severe pediatric
trauma in eastern Ontario: a descriptive analysis. J Trauma. 2002;52:8–12.
3. Lalloo R, vanAs AB. Profile of children with head injuries treated at the trauma unit
of red cross. S Afr Med J. 2004;94:544–6.
4. . Crankson SJ. Motor vehicle injuries in childhood: A hospital based study in Saudi
Arabia. Pediatr Surg Int. 2006;22:641–5.
5. Sambasivan M. Epidemeology-Pediatric head injuries. Neurol India. 1995;43:57–8.
6. Jennet B. Epidemeology of head injury. Arch Dis Child. 1998;78:403–6.

33. Fall of TV on head still remains the cause of
Pediatric TBI, as also reported by Samson et
al.7
Younger age group/ Children fare better as
also found in our study.8-11
Reference:
7. Samson SK, Nair PR, Baldia M, Joseph M. Television tip-over head injuries in
children. Neurol India 2010 Sep-Oct;58(5):752-5.
8. Alberico AM, Ward JD, Choi SC, et al.:Outcome after severe headi njury.
Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult
patients. J Neurosurg 67:648-656, 1987.
9. Andrews B, Pitts LH: Functional recovery after traumatic transtentorial herniation.
Neurosurg 2:227-231, 1991.
10. Berger MS, Pitts LH, Lovely M, et al.: Outcome from a severe head injury in
children and adolescents. J Neurosurg 62:194-199, 1985.
11. Bruce DA, Schut L, Bruno LA, et al.: Outcome following severe head injuries in
children. J Neurosurg 48:679-688, 1978.

34. Factors associated with poor outcome include
low GCS at admission and prolonged
impairment of consciousness.12
Hyperglycemia, and especially its persistance
over time, appears to be an important
negative prognostic factor. 13
References :
12. Luerssen TG. Acute traumatic cerebral injuries. In: Cheek WR eds.
Pediatric Neurosurgery. Philadelphia: W.B. Saunders, 1994;266–
278.
13. Chiaretti A, DeBenedictis R, Polidori G. Early post-traumatic seizures in children
with head injury. Childs Nerv Syst 2000 Dec; 16(12): 862-6.

35. Persistence of hypoxia on admission and CT
scan finding of SAH, DAI, Brain edema are
factors associated with poor outcome.14
Pediatric trauma score of <0 have poor
outcome as also seen in our study.15
Reference:
14. Munch E C, Bauhuf C, Horn P. et al Therapy of malignant intracranial hypertension
by controlled lumbar cerebrospinal fluid drainage. Crit Care Med 2001. 29976–981.981.
15. Campbell, John Creighton (2000). Basic trauma life support for paramedics and other
advanced providers. Upper Saddle River, N.J: Brady/Prentice Hall Health

36. Conclusion
Road traffic Accident is the major cause of
Pediatric mortality and morbidity in our
country, followed by Falls.
Need to follow “Start early, reach safely”
axiom.
India need to have “ThinkFirst For Kids
program” . And also support United Nations
“Decade of Action for Road Safety- 2011-
2020” theme.

37. The ThinkFirst For Kids program represents a
collaborative effort of educators, the ThinkFirst
National Injury Prevention Foundation, the National
Highway Traffic Safety Administration (NHTSA), the
American Academy of Pediatrics, the Peace Education
Foundation and professionals from the fields of
psychology and psychiatry.
The goal of the program is to increase knowledge and
awareness among children in grades 1-3 of the causes
and risk factors of brain and spinal cord injury, injury
prevention measures, and the use of safety habits.

38. The United Nations
General Assembly has
proclaimed the period
2011-2020 as the Decade
of Action for Road Safety,
“with a goal to stabilize
and then reduce the
forecast level of road traffic
fatalities around the world
by increasing activities
conducted at the national,
regional and global levels”.

40. Acknowledgement
Thankful to my Guides- Dr. Subodh Raju, Dr. M. A. Jaleel
To our Dean DNB- Dr. Q. Hassan
To Managing Director - Dr. Shashidhar Kamineni Sir and KHL, LB Nagar staff.
To my colleagues – Dr. Renuka Sharma, Dr. S. Ramesh. Dr. Harikishor Reddy
To Medical Records Section – Mr. Kishor,
To Pediatric and Neurosurgery department staff
To my wife – Dr. Sumedha Anjankar and my parents Dr. Deepak and Vidhya Anjankar