Head trauma (peds): Difference between revisions
Hannodavel (talk | contribs) No edit summary |
Ostermayer (talk | contribs) No edit summary |
||
| Line 12: | Line 12: | ||
== Work-Up == | == Work-Up == | ||
Do I need to obtain a head CT based on the [[EBQ:PECARN_Pediatric_Head_CT_Rule|PECARN Rule]]?<ref>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</ref> | |||
Do I need to obtain a head CT? | |||
===< 2yr old=== | ===< 2yr old=== | ||
*No CT is necessary if ALL are found: | *No CT is necessary if ALL are found: | ||
| Line 48: | Line 47: | ||
*[[Head Trauma (Main)]] | *[[Head Trauma (Main)]] | ||
*[[GCS (Peds)]] | *[[GCS (Peds)]] | ||
*[[EBQ:PECARN Pediatric Head CT Rule]] | |||
*[[Concussion]] | *[[Concussion]] | ||
*[[Skull Fracture]] | *[[Skull Fracture]] | ||
*[[Abuse (Nonaccidental Trauma)]] | *[[Abuse (Nonaccidental Trauma)]] | ||
*[[Maxillofacial Trauma]] | *[[Maxillofacial Trauma]] | ||
==External Links== | |||
*[http://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm/ MDCalc - PECARN Head Rule] | |||
== Source == | == Source == | ||
*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 | *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 | ||
<references/> | |||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 18:47, 26 June 2014
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
Do I need to obtain a head CT based on the PECARN Rule?[1]
< 2yr old
- No CT is necessary if ALL are found:
- Normal mental status
- No scalp hematoma except frontal
- LOC <5s
- Non-severe mechanism
- Severe mechanism = pedestrian or bicyclist w/o helmet struck by motorized vehicle
- Severe mechanism = fall >1m or 3ft
- Severe mechanism = head struck by high-impact object
- No palpable skull fracture
- Normal behavior per parents
>2yr old
- No CT is necessary if ALL are found:
- Normal mental status
- No LOC
- No vomiting
- Non-severe mechanism:
- Severe mechanism = pedestrian or bicyclist w/o helmet struck by motorized vehicle
- Severe mechanism = fall >2m or 5ft
- Head struck by high-impact object
- No signs of basilar skull fracture
- 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)
- EBQ:PECARN Pediatric Head CT Rule
- Concussion
- Skull Fracture
- Abuse (Nonaccidental Trauma)
- Maxillofacial Trauma
External Links
Source
- 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
- ↑ 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