Head trauma (peds): Difference between revisions
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== See Also == | == See Also == | ||
{{Head Trauma Links Template}} | |||
==External Links== | ==External Links== | ||
Revision as of 11:18, 4 July 2014
Background
- Persistence of headache, confusion, and amnesia suggests concussion
- Scalp hematoma in <2yo is assoc w/ incr risk of Skull Fracture, ICH
- Clinical symptoms (headache, vomiting, behavior change) do not correlate well with ICH
Work-Up [1]
Rules below are according to the of PECARN Head CT Study[2]
<2 years old
Any 1 of the following?
- GCS ≤14
- Altered Mental Status
- Palpable Skull Fracture
Then obtain a Non-Con Brain CT (4.4% risk of cTBI)
1 or more of the following?
- Non-frontal scalp hematoma
- LOC ≥ 5 seconds
- Severe injury mechanism
- pedestrian or bicyclist without helmet struck by motorized vehicle
- fall >1m or 3ft
- head struck by high-impact object
- Abnormal activity per parents
Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)
≥2 years old - 18 years
Any 1 of the following?
- GCS ≤14
- Altered Mental Status
- Signs of a basilar skull fracture
Then obtain a Non-Con Brain CT (4.3% risk of cTBI)
1 or more of the following?
- History of vomiting^
- LOC
- Severe injury mechanism
- Pedestrian or bicyclist without helmet struck by motorized vehicle
- Fall >2m or 5ft
- Head struck by high-impact object
- Severe headache
Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)
^Consider observation in place of imaging in children with isolated vomiting (no other indication) as the sole risk factor (0.2% risk of cTBI)[3]
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
General/Adult
Pediatric
- C-spine (peds)
- Abuse (Nonaccidental Trauma)
- GCS (Peds)
- EBQ:PECARN Pediatric Head CT Rule
- Differential diagnosis documentation#Head 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
- ↑ PECARN Rule 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
- ↑ PECARN Rule 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
- ↑ Dayan PS, et al. "Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma. June 2014. Annals of EM. 63(6):657-665