Traumatic head injury in children and young people: a national overview

A review of 6 months data from 2009 – 2010, collected from England, Wales, Northern Ireland, Channel Islands and the Isle of Man.

This report is an analysis of data on 5700 children with mild, moderate and severe traumatic head injury (THI) from 2009 to 2010. The inclusion criterion for entry into the study was that the child had been in receipt of treatment or observation in an inpatient area for at least 4 hours. Therefore, it is important to note that this dataset includes many children with minor head injury who would have been sent home shortly after this time and relatively few children with severe traumatic head injury.

In addition, there have been significant changes in trauma care management in England (and parts of Wales) since the date of this data collection and analysis which came into being in April 2012.1 This included the development of structured networks of care, based on a hub and spoke model, the spokes being Trauma Units (TU) and the hub being the Regional Major Trauma Centre (MTC).

Other aspects of clinical practice have also changed since the time that the study was conducted, for example, NICE 2007 guidelines on the management of head injury in children and young people were revised in 2014, and new guidance on imaging produced by the Royal College of Radiology in 2014 have come into play.

The importance of the data in this report is that it acts as a comprehensive benchmark of service delivery prior to the re-organisation services and introduction of new guidance.

The specific areas considered in the analysis of this data were:

• The epidemiological features of traumatic head injury in children and young people.
• The causes of traumatic head injury.
• The assessment and management of traumatic head injury in prehospital and in-hospital settings.
• The use of CT head scanning and compliance with NICE head injury guidance (2007).
• How children with suspected maltreatment and abusive head trauma were investigated and managed.

Importantly, the data have also been incorporated into a series of forthcoming peer-reviewed publications, which benchmark activity prior to the advent of the trauma system in operation in England and parts of Wales.

Recommendations

Based on the detailed analysis of this dataset, together with the clinical and academic input and consensus of the Independent Advisory Group for this project a number of recommendations have been produced. Full details of the analysis that led to these conclusions and recommendations are included in the report.