The fear of having a serious pathology with the symptoms of head trauma and the promt for exclusion of pathologies by imaging methods increase the admissions to the emergency services. Nowadays, the increasing frequency of admissions may be due to parents' level of awareness about head trauma, easy access to health services or anxiety and depression levels of parents.
Two hundred children with mild head trauma under 5 years of age were included in the study. After the initial evaluation, a descriptive form and the hospital anxiety and depression scale was filled in order to determine the risk of current anxiety and depression.
The reasons for admission were 37% claim for an imaging modality and 59% being afraid of having an important pathology. However, no significant relationship was found between the anxiety and depression subscale cut-off score. When diagnostic pathologies were examined, anxiety scores were higher in the presence of nasal fractures.
We conclude that the panic and tension situation encountered in the parents of the children we evaluated with head trauma, a general control request, or the persistence of imaging cannot be explained by the current anxiety and depression.
Anxiety, Depression, Head trauma, Emergency
Childhood head trauma is an important part of the applications for trauma to the emergency department and is the leading cause of mortality and morbidity in this age group [1,2]. The majority of traumas are mild head traumas. Although it often occurs with a low-energy mechanism, it causes a severe fear and panic in family members. For this reason, a child, whose general condition is still good, is entering the emergency room with an accompanied by panic, crying and shouting. Especially in our country, the frequency of referral is increasing and even for common reasons such as falls or toy related injuries leaves the physician and parents over against who are worried about having an important pathology or claim for an imaging modality. At this stage, even after the examination and evaluation of the child, and using diagnostic algorithms for necessity of imaging modalities parents usually be urgent about imaging modalities and parents are informed and explained for a long time about follow-up process. Reduction of follow-up period, persistence of radiologic imaging often leads to undesirable situations. Patients are frequently discharged with no significant pathology and conditions for applying again to the emergency service explained detail. Evaluated children are usually mild head trauma and associated skin incision or bleeding increases the level of anxiety in patients. In-house fall or simple skin edema has not been an important cause of admission but nowadays it brings agitated and anxious urgent applications. This may be due to people's level of consciousness about head trauma, easy access to health services, or anxiety and depression levels of parents. The aim of this study was to investigate the relationship between depression and anxiety levels of the parents of children who were evaluated by minor head trauma and their emergency admission reasons.
Two hundred children with mild head trauma under 5 years of age were included in the study Moderate and severe head injuries were excluded. After the first evaluation and initial treatment, during the observation period a descriptive form including information about the child and the hospital anxiety and depression scale filled by the parents. Written approval was obtained from the ethics committee of our hospital during the study planning phase.
Categorical variables are summarized as numbers and percent. Pearson Chi-Square was used in 2 × 2 tables and Fisher Freeman Halton Test was used in the difference comparisons between categorical variables. Jamovi project (2018). Jamovi (Version 0.9.0.3) [Computer Software]. (Retrieved from https://www.jamovi.org) (Open source) and the statistical analysis of the level of significance (p-value) was considered as 0.05.
Clinical findings of children with head trauma are highly variable depending on the severity of trauma. Pediatric The Glasgow Coma Scale (GCS) is often used to assess the state of consciousness and to estimate the severity of injury. Generally, the presence of neurological deficits or new-onset clinical signs indicate pathological changes related to head trauma and require careful evaluation. Patients who are exposed to head trauma but whose consciousness is unchanged and who have GCS 14-15 in their neurological examinations are evaluated as mild head trauma . It is decided in the direction of evidence based clinical algorithms to determine the need for imaging in blunt head trauma .
Hospital Anxiety and Depression Scale is a four-point Likert-type scale developed by Zigmond, et al. to identify patients risk for depression and anxiety, to measure the level and severity . Total of 14 questions and odd numbers measure the anxiety and even numbers measure the depression level. The validity and reliability study of the form was done by Aydemir and it was determined to be safe. It consisted of two subscales: Anxiety (HAD-A) and depression (HAD-D). In Turkey outcome studies anxiety subscale cut-off score was 10/11, depression cut-off score was 7/8. The minimum score that can be obtained from both scales is 0 and the maximum score is 21 .
When the trauma mechanisms of the children included in the study were examined, it was observed that the most frequent was 61.5% falls. 84% of the trauma occurred at home. 39.5% of the children included in the study were first child, 92.5% had old head trauma and 1% had systemic disease. According to physical examination findings, it was found that 33.5% did have normal findings and 34% had scalp swelling, 17.5% had scalp incision and bleeding. According to the pathology findings, 94.5% of the patients had no pathology, 4.5% of them had linear fractures and 0.5% of them had nasal fractures. The occurrence of the traumas did not show a significant difference during the day, while the person who undertook the child was 93% mom and 93.5% was housewife. The mechanisms of trauma and existing pathologies are summarized in Table 1.
Table 1: Study group demographics. View Table 1
When the reasons for emergency admissions were examined, 12.5% had vomiting, 2.5% had headache, 12% for general control, and 37% had the desire to imaging studies, and 59% fear of something important happens. When the anxiety status of the parents of the children included in the study was examined, 87.5% were below the threshold (0-10), 12.5% were above the threshold (11-21), and the depression status was below 60%. (0-7) and 40% above threshold (8-21).
A statistically significant relationship was found between the pathology rates of the parents of the children included in the study according to hospital anxiety levels (p = 0.021). Parents' anxiety scores were higher in the nasal fracture group and necessity of clinical follow-up Table 2.
Table 2: Comparison of the anxiety subscale. View Table 2
There were no statistically significant relationships between the causes of admission to the emergency room, trauma mechanism and existing pathologies in the evaluation based on the anxiety subscale cut-off score. The data are summarized in Table 3 and Table 4.
Table 3: Relationship between the cut-off point of Anxiety subscale and the cause of emergency admissions. View Table 3
Table 4: Relationship between the cut-off point of anxiety subscale and the mechanism of trauma and its consequences. View Table 4
When the depression subscale scores of the children in the parents of the children were examined, there was no statistically significant relationship between the first child, the presence of systemic disease, physical examination findings and the pathology rates, and the reasons for admission to the emergency department (p > 0.05 for each of the children). The data are summarized in Table 5 and Table 6.
Table 5: Depression subscale cut-off score. View Table 5
Table 6: Relationship between the cut-off point of depression subscale and the cause of emergency admissions. View Table 6
There was no significant correlation between depression subscale scores of parents and the presence of traumatic variables or a history of old head trauma Table 7.
Table 7: Relationship between the cut-off point of depression subscale and the mechanism of trauma and its consequences. View Table 7
Childhood head trauma is the most serious public health problem not only in developing countries but also in developed countries. In many studies, it has been pointed out that traumas such as falls, high falls or traffic accidents, which are the main etiological reasons of childhood traumas, can be prevented or prevented before they occur with effective measures and training [1,7-9]. This can only be achieved by identifying the problem and bringing solutions.
An increase in the level of awareness about head traumas may increase the status of parents who encounter this situation and adaptation to the physician's referrals in the referenced health institution. We believe that minor head trauma to emergency departments and insistence of current response and imaging methods at the time of admission are due to insufficiency and misleading information level. In order to prevent this situation, more education can be given to public education.
The most evident reaction of individuals to the disease in general is anxiety, fear and panic.
These reactions have been shown to have an effect on patient healing and behavior. Reactions such as tension, anger and depression can be observed in the presence of disease. Anxiety and depression reactions of individuals to the disease may affect the way they deal with the disease. These responses may increase, especially in pathologies requiring surgery and the need for surgery .
Whether an event is perceived as stressful or not depends on the nature of the incident and the person's coping and defense mechanisms. Anxiety warns of imminent dangers and allows the person to take measures to cope with the threat element . In our study, we observed that the face, such as nasal fracture, had a certain deformity from the outside, or increased in cases of overt injury such as edema and ecchymosis. We are of the opinion that the fear of fear of additional injury as a result of permanent damage development or the fear of additional injury is reflected in their anxiety levels. Communicating with the families in the intensive care setting in the intensive care setting may have positive consequences for the patient follow-up. In multicentre studies conducted, it was shown that the physician's communication with the family may increase the patient compliance especially in the case of imaging and follow-up decisions in minor head trauma .
The low level of education of parents of sick children may affect the data of our study.
Low levels of education, lack of knowledge about the disease, incorrect attitudes and insufficiency of problem solving capacity may have played a role in the anxiety and depression levels of parents of sick children.
In our study, we concluded that the panic and tension we encountered in the parents of the children we evaluated were independent of the current anxiety and depression levels. In the presence of an open nasal trauma, independent of the intracranial injury, we found that parents' anxiety levels were higher. The cause of this difference can be explained by the state of concern in the presence of parental injuries or paralysis in the face of a more common injury such as a nasal fracture. We found that a general control request or imaging insight in intracranial injuries is not at levels that can be explained by current anxiety and depression. This may be due to different reasons, such as the inability to deal with the incident or a lack of information. It can be considered as one of the effective solution methods.
The common causes of emergency admission for minor head trauma are parents fear of something important happens and desire to imaging modalities to exclude intracranial pathology.
Despite minor injuries admissions reasons cannot be explained by the current anxiety and depression levels of parents. This may be due to different reasons, such as the inability to deal with the incident or a lack of knowledge.
There is no financial and non-financial competing interest.
There is no conflict of interest between authors.