1108 - Pediatric Traumatic Brain Injury From Occipital Impact: A Rare Case Of Accidental Trauma

Case Diagnosis: A 12-month old girl presented with a severe traumatic brain injury (TBI) following a 3-foot fall from bed with occipital impact resulting in a subdural hematoma (SDH) and bilateral retinal hemorrhages. She underwent emergent evacuation and craniectomy at an outside hospital. This case raises discussions about the etiology of injury and prognosis in such pediatric patients.

Case Description: This patient presented with a poor prognosis due to her severe TBI, cerebral edema, and brain tissue herniation. She remained intubated and sedated for a prolonged period of time. Multiple specialties were consulted to determine treatment versus comfort care. Tracheostomy was recommended, but ultimately, she tolerated extubation and progressed through the stages of TBI. She was discharged to inpatient rehabilitation where she continues to make progress with functional mobility and oral feeding, despite a setback due to infection of her bone flap with subdural empyema.

Discussions: This case report highlights a multidisciplinary approach towards a challenging pediatric TBI case. Initially there was recommendations for a brain death exam as well as concern for non accidental trauma given the severity of her injury and symptoms. It is important to consider a multidisciplinary approach when evaluating such patients with the goal of recovery of function. Typically, pediatric falls from a similar height do not result in such severe injuries. There are similar cases of pediatric occipital impacts from a low height causing severe TBI cases such as this in an accidental setting.

Conclusions: Pediatric traumatic brain injuries from direct occipital impact leading to subdural hematoma and retinal hemorrhages can be very detrimental to the patient and sometimes fatal. Abusive head trauma must be ruled out in these cases, and consideration must also be given for direct occipital impact from an accidental trauma causing severe brain injuries not commonly caused by similar falls in the pediatric population.