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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 5-8

Computed tomographic evaluation of pediatric head injury in Aminu Kano Teaching Hospital, Kano, Nigeria


Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication5-Mar-2019

Correspondence Address:
Dr. Abdu Hamisu Dambatta
Department of Radiology, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_15_18

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  Abstract 


Objective: To describe the computerized tomographic findings in children with head trauma who presented at the Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: It is a retrospective review of patients aged 9 month to 12 years with suspected head injury following head trauma, who presented for CT scan at Aminu Kano Teaching Hospital, Kano, Nigeria from January 2016 to December, 2017. Results: Sixty eight cases were reviewed retrospectively. They ranged from 9 months to 12 years with the mean age of 5 years. Fifty four (79.4%) were males. Fourteen were females (20.6%). Thirty five (51.5%) had head injury secondary to RTA. Twenty four (35.3%) had a history of fall from height. Four (5.9%) had a history of fall into a well. Four (5.9%) had a history of assault. Only one had a history of gun shot (1.5%). Twenty one patients (30.9%) had normal findings. Five (7.4%) of them had a frontal bone fracture. Seven (10.3%) had a parietal bone fracture. Two (2.9%) had fracture of base of the skull. Seventeen (25%) had intracerebral haematoma. Three had brain oedema (4.4%). One had epidural haematoma (1.5%). Eight (11.8%) had subdural haematoma. Six (8%) had combined fracture with cerebral contusion. Conclusion: RTA is a major cause of head injury in the most paediatric age group in our environment with CT scan as a valuable imaging tool in the investigation and management of these patients.

Keywords: AKTH, CT, paediatric head injury


How to cite this article:
Dambatta AH, Sidi M. Computed tomographic evaluation of pediatric head injury in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Basic Clin Sci 2019;16:5-8

How to cite this URL:
Dambatta AH, Sidi M. Computed tomographic evaluation of pediatric head injury in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2019 [cited 2019 Nov 15];16:5-8. Available from: http://www.njbcs.net/text.asp?2019/16/1/5/253402




  Introduction Top


Head injury refers to trauma to the head. This may or may not include injury to the brain,[1] and is an important cause of morbidity and mortality worldwide. Its incidence varies in different geographical regions; however, it is increasing across all age groups, including children, in Nigeria.[2] Children are particularly at risks for injuries because they are unable to recognize and avoid many potential risks for injuries due to their low level of judgment.[3] Some of the risk factors for pediatric injuries include poverty, single-parent households, other siblings, poor maternal mental/physical health, marital discord, and child abuse/neglect.[4] Others include road crossing and school resumption and closure. Children do cross-busy roads to and from school without supervision. This has increased the incidence of trauma and is fast becoming a leading cause of death among the pediatric age group of 0–15 years.[5] There are two types of childhood head injury, which include closed and penetrating head injuries.

The exact scope of the burden of pediatric trauma is difficult to ascertain in Nigeria, particularly in Kano, as there are very few reports about this emerging public health problem. The health care including other developing countries is mainly focused on the prevention and control of communicable diseases and malnutrition, with little attention given to trauma in children.[6] There are, however, some reports in other parts of Nigeria such as Chinda et al. (2013) in Maiduguri[7] and Danjuma et al. (2016) in Kaduna,[8] and also reports from Sokoto, Jos, Zaria, Ilorin, and Abuja. Therefore, it is time to arise to the challenge of publishing and documenting experience in the area of trauma including pediatric trauma. Such information is necessary for assessing the impact of trauma on child health and for setting priorities to improve pediatric care.

The imaging modalities for evaluation of patients with head injury mostly include plain radiography, transcranial Doppler ultrasound, computed tomography (CT), and magnetic resonance imaging. However, cranial CT has emerged as the mainstay in the diagnostic workup of patients with head injury, particularly in the initial assessment of the head injured because of its availability, short image acquisition time, and its accuracy in the detection of skull fractures and intracranial hemorrhage.[9] Therefore, its usefulness in the setting of trauma should outweigh its risk of radiation exposure in children.

The aim of the study was, therefore, to describe the computerized tomographic findings in children with head trauma who presented at the Aminu Kano Teaching Hospital, Kano, Nigeria.


  Materials and Methods Top


It is a retrospective review of patients aged 9 months to 12 years [Figure 1] with suspected head injury following head trauma, who presented for CT scan at Aminu Kano Teaching Hospital, Kano, Nigeria from January 2016 to December, 2017. A 160-slice Aquilium Prime CT scanner (Toshiba, Japan, 2011) was used to acquire the images. The reported CT images by consultant radiologists were retrieved and analyzed. The findings were broadly classified into normal and abnormal. Abnormal findings were further classified into extracranial: cranial fractures with soft tissue injuries. Other abnormal classifications that included intracranial hematomas, extradural and subdural hematomas, intracerebral hematoma or contusion, cerebral edema, and hematomata were noted as acute (hyperdense on CT). There are, however, two broad types of head injury that include closed and penetrating head injuries in children.
Figure 1: Age groups of the children

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  Results Top


A total of 68 cases were reviewed. They ranged from 9 months to 12 years with the mean age of 5 ± 3.14 years. Among the cases, 54 (79.4%) were males and 14 were females (20.6%). A total of 35 (51.5%) had head injury secondary to RTA [Figure 2]; 24 (35.3%) had a history of fall from height; 4 (5.9%) had a history of fall into a well; 4 (5.9%) had a history of assault. Only one had a history of gunshot (1.5%).
Figure 2: Etiology of head injury in children. RTA = road traffic accident; FFH = fall from height; FIW = fall into wall; A = assault; GS = gunshot

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CT findings

Normal findings: 21 patients (30.9%) [Figure 3].
Figure 3: Findings. BA = brain edema; EH = epidural hematoma; SH = subdural hematoma; F and CC = fracture and cerebral contusion; N = normal findings; FBF = frontal bone fracture, PBF = parietal bone fracture; FBS = fracture base of the skull; ICH = intracerebral hematoma

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Fractures: frontal bone – 5 patients (7.4%); parietal bone – 7 (10.3%); base of the skull – 2 (2.9%).

Hematomas: intracerebral – 17 (25%); extracerebral–epidural – 1 (1.5%), subdural – 8 (11.8%) [Figure 4] and [Figure 5].
Figure 4: (a) 3D sagittal CT image of the skull showing fronto-parietal fracture in a 3-year-old child. (b) Axial noncontrast-enhanced CT image of the same child showing a biconvex hyperdensity adjacent to the inner table of the right parietal bone with associated effacement of the body of ipsilateral lateral ventricle indicating acute epidural hematoma

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Figure 5: (a) 3D sagittal CT image showing a comminuted depressed skull fracture involving temporo-parietal region of the skull in a 2-year-old child. (b) Axial noncontrast-enhanced CT image of the same child showing a comminuted fracture with associated irregularly shaped hyperdensities in the right parietal lobe with surrounding hypodensity due to edema in keeping with intracerebral hematoma. There is also overlying soft tissue swelling and subcutaneous emphysema

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Brain edema: 3 (4.4%).

Combined fracture with cerebral contusion: 6 (8%).


  Discussion Top


The study was aimed at describing the computerized tomographic findings of head trauma. This is a hospital-based study and does not include information on children who died before reaching hospital. Also, those with minor injuries who would have presented to a hospital of lower grade or not attended any health facility at all were not included.

There were 68 children in our study with 79.4% males and 20.6% females. Danjuma[7] in Kaduna, Nigeria found 67.6% males and 32.4% females. Udoh and Adeyemo[2] in Benin, Nigeria, found 51.2% males and 48.8% females. Emejulu and Shokunbi[10] in Nnewi, Nigeria, found 62% males in their study. Chinda et al.[8] in Maiduguri, Nigeria, found 66.7% males in their study. The greater willingness of the male child to undertake risky adventures can explain these findings. The boys also like to explore the environment and play with the peers, making them exposed to more danger.

Road traffic accident (RTA) was the most common etiologic factor in this study, a finding that agrees with other reports on head injury in Nigeria.[11],[12],[13],[14],[15] The deplorable condition of Nigerian roads is primarily responsible for this. Other causes of head trauma in our study population include falls from height 24 (35.3%), fall into a well 4 (5.9%), assault 4 (5.9%), and gunshot 1 (1.5%). The child's adventurous nature may account for the fall from height and into a well. Gunshot injuries are on the increase in contemporary Nigeria.[16] Fall from height was the second commonest cause in our study similar to South Africa and Malawi, where fall from height was the commonest cause of injury representing 43 and 42.9%, respectively, unlike in Sokoto, Nigeria where it was not common.[17] However, study in Nigeria found equal incidence of RTA and falls.[10] The high incidence of RTA-related head trauma in this study calls for an urgent review and strict enforcement of traffic laws in Nigeria as has been previously stated.[10]

The most common cranial CT abnormality found in this study was intracranial hemorrhage seen in 32 patients (46.3%) with or without fracture. This is in agreement with the findings on CT of head injured patients in some research work in Nigeria.[18],[19] These intracranial bleeds were mostly intracerebral (33%). Extra-axial bleeds were uncommon as a single lesion in this study with subdural 8 (11.8%) and epidural 1 (1.5%) cases, respectively. On CT, acute subdural hematoma appears as a crescent-shaped, while epidural appears as biconvex, homogenously hyperdense extra-axial collection. Intraventricular and subarachnoid hemorrhages are not seen in our study.

Fractures can involve the vault, skull base, or facial skeleton and may be linear, depressed, or comminuted types. An incidence of 28.6% of skull fractures was found in the abnormal patients, with few of these associated with intracranial lesions, particularly intracerebral hemorrhage (8%). These lesions were ipsilateral to the fracture sites. The fractures involved the cranium in 20 patients (82%) and the base in 2 patients (2.9%). The parietal bones (18.3%) and frontal bones (7.4%) were also involved. The explanation for this is probably because these are the most convex areas of the calvarium, and the more prone to impact.


  Conclusion Top


RTA is the commonest cause of pediatric head injury in Kano, while the most common abnormal finding in this study was intracerebral hemorrhage. CT remains a very important modality in the management of patients with head injury. However, it must be used judiciously in patients because of the sensitive nature to the hazards of ionizing radiation, particularly in children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
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Ogbeide E, Isara A.R. Cranial computed tomography utilization in head trauma in a Southern Nigerian tertiary hospital. Sahel Med J 2015;18:27-30.  Back to cited text no. 16
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Agrawal A, Galwankar S, Kapil V, Coronado V, Basavaraju SV, McGuire LC, et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India 2007-2009. Int J Crit Illn Inj Sci 2012;2:167-71.  Back to cited text no. 19
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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