Direct comparisons between pediatric traumatic intracranial hemorrhages (ICH) are limited. This study describes types of ICH and their outcomes, including differences between accidental (AT) and non-accidental trauma (NAT).Methods: A retrospective study at a level 1 trauma center in patients < 18 years (n=202) between 01/2014 and 03/2021 with traumatic ICH. Data collected included demographics, type of ICH, presentation, neuroimaging, injury severity score (ISS), and confirmed NAT. Outcomes included ICU/hospital length of stay (LOS) in days (d), and patient disposition. Comparative statistics were performed between groups.
Mean age was 5.6 years. 11 patients died (5.4%). Patients were grouped into epidural hematoma (EDH; n=35), subdural hematoma (SDH; n=98), intraparenchymal hemorrhage (IPH; n=15), subarachnoid hemorrhage (SAH; n=29), and mixed lesions (MIX; n=25). Patients with EDH were more likely to have askull fracture (p < .01), higher ISS (p < .01), shortest ICU (3.5±3.7d; p < .01)/hospital (4.9±5.6d; p=.01) LOS, and highest rate of disposition home (97%). Patients with SDH were younger (48.0±64.0 months), more often had loss of consciousness, the highest rate of confirmed NAT (p < .01) and disposition to foster care (p < .01). SAH group had the lowest ISS (14.5±11.0) and no other differences in outcomes compared to other groups. There were no significant differences between IPH group outcomes and others. MIX group had the longest hospital (25.4±41.6 d)/ICU (12.1±13.4d) LOS. Secondary analysis showed 58 confirmed NAT patients and 144 AT patients. NAT patients were younger (18.1±37.0 vs 87.6±69.0 months; p < .01) and more likely to present with isolated SDH (74% vs 39%; p < .01). More often, patients in AT had penetrating head injury (18% vs 1%; p < .01), skull fracture (61% vs 27%; p < .01) and shorter hospital LOS (8.3±11.3 vs 17.8±27.9; p < .01).
Patients with EDH had better outcomes despite high ISS; patients in the MIX group had the worst outcomes. Patients with NAT had higher incidence of SDH and worse outcomes than AT.