Head trauma (peds)

Definition

• Normal mental status at the initial examination
• No abnormal findings on neuro exam
• No physical evidence of skull fx

Background

• Persistence of HA, confusion, and amnesia suggests concussion
• Worsening of symptoms suggests intracranial injury
• Scalp hematoma in <2yo is assoc w/ incr risk of skull fx, ICH
• Clinical symptoms (HA, vomiting, behavior change) do not correlate well with ICH

Work-Up

(Consider PECARN Study. PECARN Pediatric Head Injury/Trauma Algorithm at http://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm/)

Do I need to obtain a head CT?

< 2yr old

• No CT is necessary if ALL are found:

1. Normal mental status
2. No scalp hematoma except frontal
   1. LOC <5s
3. Non-severe mechanism
   1. Severe mechanism = pedestrian or bicyclist w/ohelmet struck by motorized vehicle
   2. Severe mechanism = fall >1m or 3ft
   3. Severe mechanism = head struck by high-impact object
4. No palpable skull fracture
5. Normal behavior per parents

>2yr old

• No CT is necessary if ALL are found:

1. Normal mental status
2. No LOC
3. No vomiting
4. Non-severe mechanism:
   1. Severe mechanism = pedestrian or bicyclist w/o helmet struck by motorized vehicle
   2. Severe mechanism = fall >2m or 5ft
   3. Head struck by high-impact object
5. No signs of basilar skull fracture
6. No severe headache

Disposition

• Discharge if:
  • Asymptomatic after 2-4hr obs (not vomiting, nl neuro exam, nl mental status)
  • Head CT normal (delayed deterioration after normal CT is near zero)
• Consider discharge if:
  • Nondisplaced fx w/o intracranial injury (in consultation w/ neurosx)

See Also

• Head Trauma (Main)
• GCS (Peds)
• Concussion
• Skull Fracture
• Abuse (Nonaccidental Trauma)
• Maxillofacial Trauma

Source

• Tintinalli
• Kupperman N, Holmes JF, Dayan PS, et al: Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374(9696): 1160, 2009
• Holmes et al. Do Children With Blunt Head Trauma and Normal Cranial CT Require Hospitalization for Neurologic Observation?, Annals of Emergency Medicine, vol 58, 2011