Motor vehicle crash brain injury in infants and toddlers: A suitable model for inflicted head injury?

Children involved in motor vehicle crash (MVC) events might experience angular accelerations similar to those experienced by children with inflicted traumatic brain injury (iTBI). This is a pilot study to determine whether the progression of signs and symptoms and radiographic findings of MVC brain injury (mvcTBI) in children of the age at greatest risk of iTBI could be evaluated with retrospective data. The ultimate goal was to examine the association of subdural hematoma (SDH) with initial loss of consciousness (LOC) and outcome. Retrospective review of records was conducted of 51 patients involved in a MVC, between birth and 36 months, admitted to Harborview Medical Center between January 1996 and December 2001. Radiographs were reviewed. Simple descriptive statistics and Fisher's exact test were used. Ambulance reports were available for 57% of the patients, while Glasgow Coma Scale (GCS) scores (from any source) were only available for 76% of patients. Thirty-nine percent of patients sustained skull fractures, 8% long bone fractures, 20% thoracic injuries, and 8% intra-abdominal injuries. Twenty-four percent of the patients had SDHs; half of these experienced LOC. SDH patients without initial LOC had computed tomography findings and clinical courses indicative of focal impact injury, not angular acceleration. Initial LOC and subsequent evolution of GCS scores are inconsistently documented in retrospective records. Seven of the 12 patients with SDHs had simple contact injuries, while 5 exhibited diffuse brain injury. Initial LOC was associated with diffuse brain injury and poor outcome. Due to the high rate of simple contact injury, mvcTBI may be a difficult model for iTBI. Los niños implicados en accidentes de vehículos a motor (AVM) pueden experimentar aceleraciones angulares similares a aquellas experimentadas por los niños con lesiones cerebrales por trauma inducido (LCTi). Este es un estudio piloto para determinar si la progresión de los signos y los síntomas y los hallazgos radiológicos del daño cerebral por AVM en niños de edades con mayor riesgo de LCTi pueden ser evaluados con datos retrospectivos. El objetivo final es evaluar la asociación del hematoma subdural (HS) con pérdida inicial de conciencia y su pronóstico. La revisión retrospectiva de los archivos fue llevada a cabo en 51 pacientes implicados en un AVM con menos de 36 meses admitidos en el Centro Médico Harborview entre Enero de 1996 y Diciembre de 2001. Fueron revisadas las radiogr