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Évaluation des recommandations de la SFMU sur la prise en charge du traumatisme crânien léger dans une cohorte de nourrissons n’ayant pas acquis la marche : étude rétrospective incluant 1 910 enfants de 2007 à 2011 admis aux urgences pédiatriques de l’hôpital des Enfants du CHU de Toulouse

Minor head trauma management — Assessment of SFMU guidelines in a cohort of infants before walking acquisition: Retrospective study between 2007 and 2011 of 1,910 infants admitted to the Pediatric Emergency Department of Toulouse University Hospital

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Objectif

Comparer le nombre de tomodensitométries cérébrales (TDMc) préconisées selon l’application du protocole de service d’un Service d’accueil des urgences (SAU) pédiatrique à celui des recommandations de la Société française de médecine d’urgence (SFMU) sur les traumatismes crâniens légers (TCL) (2012).

Matériel et méthode

Étude rétrospective observationnelle entre le 1er janvier 2007 et le 31 décembre 2011 incluant tous les enfants âgés de neuf mois ou moins admis au SAU pédiatrique à la suite d’un TCL survenu dans un contexte de chute à domicile. A été collecté, à partir du dossier médical et radiologique et pour chaque enfant, l’ensemble des informations permettant d’établir les critères d’indication de TDMc selon le protocole interne d’une part et selon les critères SFMU d’autre part, soit: âge, facteurs de risque identifiés de lésions intracrâniennes (LIC) [hauteur supérieure à 90 cm, hématome temporopariétal fluctuant, examen neurologique anormal, fracture du crâne, perte de connaissance initiale (PCi), comportement de l’enfant, suspicion de maltraitance, vomissements répétés à distance du TC].

Résultats

Quarante-quatre TDMc supplémentaires à réaliser en urgence étaient préconisées par le protocole interne par rapport au protocole de la SFMU sur les 1 910 nourrissons. Parmi les 28 TDMc supplémentaires effectivement réalisées, cinq LIC ont été mises en évidence. Concernant les 23 examens supplémentaires normaux, 65 % (n = 15) des enfants ont bénéficié d’un signalement auprès des services sociaux pour une suspicion de maltraitance ou de négligence.

Conclusion

L’application rétrospective des recommandations de la SFMU sur le TCL de l’enfant montrait un taux de détection de LIC plus faible (10 % [n = 5] non détectées) dans le groupe à haut risque de LIC. Certaines situations de maltraitances n’auraient pu être mises en évidence dans notre cohorte.

Abstract

Objectives

To compare the number of cerebral CT scan respectively recommended for pediatric minor head trauma by the application of the Pediatric Emergency Unit protocol and the recent SFMU guidelines.

Patients and methods

Between 2007 and 2011, all children aged 9 months or younger admitted after a domestic accidental minor head trauma to a tertiary level Pediatric Emergency Unit were included. To determine criteria for brain CT scan recommendation (internal protocol vs. SFMU guidelines), data were collected for each child from both medical and radiologic records. Collected data were: age and the risk factors of traumatic brain injury (TBI) such as height of fall over 90 cm, temporo-parietal hematoma, skull fractures, neurological impairment, loss of consciousness, suspicion of child abuse, and delayed repeated vomiting.

Results

The application of the internal protocol recommended 44 extra brain CT scan compared to the application of the SFMU guidelines. Among these additional recommended scans, 28 exams were actually performed and 5 TBI detected. A situation of abuse was identified and reported to social service in 65% (N = 15) of the 23 normal scans.

Conclusion

The recent SFMU guidelines were not able to detect 10% of total TBI (N = 5) missing child abuse in the TBI high-risk group.

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Authors and Affiliations

  1. Pôle Samu-Urgences, centre hospitalier d’Albi, 22, boulevard du Général-Sibille, F-81000, Albi, France

    A. -L. Chevrin

  2. Samu-Urgences adultes-Urgences pédiatriques, hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, F-31059, Toulouse cedex, France

    T. Hamon

  3. Pôle de médecine d’urgence, hôpital Purpan, CHU de Toulouse, université Paul-Sabatier-III, 118, route de Narbonne, F-31062, Toulouse, France

    V. Bounes

  4. Pôle de médecine d’urgence, hôpital Rangueil, CHU de Toulouse, université Paul-Sabatier-III, 118, route de Narbonne, F-31062, Toulouse, France

    S. Charpentier

  5. Pôle spécialisé d’urgences (POSU) pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande Bretagne, TSA 70034, F-31059, Toulouse cedex 09, France

    I. Claudet

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  1. A. -L. Chevrin
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  2. T. Hamon
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  3. V. Bounes
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  4. S. Charpentier
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  5. I. Claudet
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Correspondence to A. -L. Chevrin.

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Chevrin, A.L., Hamon, T., Bounes, V. et al. Évaluation des recommandations de la SFMU sur la prise en charge du traumatisme crânien léger dans une cohorte de nourrissons n’ayant pas acquis la marche : étude rétrospective incluant 1 910 enfants de 2007 à 2011 admis aux urgences pédiatriques de l’hôpital des Enfants du CHU de Toulouse. Ann. Fr. Med. Urgence 6, 99–105 (2016). https://doi.org/10.1007/s13341-016-0624-1

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  • DOI: https://doi.org/10.1007/s13341-016-0624-1

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