Head trauma (peds): Difference between revisions

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== Definition ==
== Definition ==
*Normal mental status at the initial examination
*Normal mental status at the initial examination
*No abnormal findings on neuro exam
*No abnormal findings on neuro exam
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== Diagnosis ==
== Diagnosis ==
 
*Persistence of HA, confusion, and amnesia suggests concussion
persistence of symptoms such as headache, confusion, and amnesia suggests concussion Worsening of symptoms suggests intracranial injury
*Worsening of symptoms suggests intracranial injury
 
*Scalp hematoma in <2yo is a/w incr risk of skull fx, ICH
A scalp hematoma in a child <2 years of age is associated with an increased risk of skull fracture and intracranial hemorrhage.
*Clinical symptoms (HA, vomiting, behavior change) do not correlate well with ICH
 
Clinical symptoms such as headache, vomiting, and behavior change do not discriminate well between children with and without intracranial hemorrhage. Post-traumatic headache, for example, may be a symptom of concussion or intracranial hemorrhage. Vomiting is relatively common and does not predict intracranial hemorrhage.12 Vomiting after MHI is typically transient (diminishing over a number of hours) and is more common in children >2 years of age.13 One small study, in fact, noted a decreased incidence of vomiting in children with more severe head injuries.13 Vomiting with MHI may also be more prevalent in those children with a history of migraine or a family history of migraine.14 Although studies of adult head injury identify vomiting as a risk factor for intracranial injury,15 it is multiple episodes of vomiting in children that represent a risk factor for intracranial injury
 
 


== Work-Up ==
== Work-Up ==
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#No vomiting
#No vomiting
#^Non-severe mechanism
#^Non-severe mechanism
No signs of basilar skull fracture
#No signs of basilar skull fracture
No severe headache
#No severe headache


^Non-severe Mechanism:
*^Non-severe Mechanism:
#Pedestrian or bicyclist w/o helmet struck by motorized vehicle
#Pedestrian or bicyclist w/o helmet struck by motorized vehicle
#Fall >2 m or 5 ft (age >2 y) or >1 m or 3 ft (age <2 y)
#Fall >2 m or 5 ft (age >2 y) or >1 m or 3 ft (age <2 y)
#Head struck by high-impact object
#Head struck by high-impact object


== Treatment ==
==Disposition==
 
*D/c asymptomatic pts (not vomiting, nl neuro exam, nl MS) after 2-4hr obs
*sedate & paralize prn (barbiturate coma can decr metabolism & ICP)
*D/c pt if head CT normal (delayed deterioration after normal CT is near zero)
 
*Dispo decision for nondisplaced fx w/o intracranial injury should be made w/ neurosx
*pCO2 (target = 30-35)
 
*HOB @ 30 degrees,
 
*prevent jugular venous compression w/ c-collar
 
*Goal= maintain CPP (MAP-ICP), cpp of 40-65 is goal, better survival if 40-50
 
*Prevent hypotension
 
*Keep Hgb >
 
*Mannitol .25-1g/kg in boluses
 
*Dilantin
 
*Must operate on sig depressed skull fx
 
 


== See Also ==
== See Also ==
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[[Head Trauma (Adult)]]
[[Head Trauma (Adult)]]


==  ==


== Source ==
== Source ==
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Tintinalli
Tintinalli


AAP Guidelines
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
 


<br/>[[Category:Peds]] <br/>[[Category:Trauma]] <br/><br/><br/>
[[Category:Peds]]  
[[Category:Trauma]]

Revision as of 23:00, 26 June 2011

Definition

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

Diagnosis

  • Persistence of HA, confusion, and amnesia suggests concussion
  • Worsening of symptoms suggests intracranial injury
  • Scalp hematoma in <2yo is a/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?

<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
  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
  5. No signs of basilar skull fracture
  6. No severe headache
  • ^Non-severe Mechanism:
  1. Pedestrian or bicyclist w/o helmet struck by motorized vehicle
  2. Fall >2 m or 5 ft (age >2 y) or >1 m or 3 ft (age <2 y)
  3. Head struck by high-impact object

Disposition

  • D/c asymptomatic pts (not vomiting, nl neuro exam, nl MS) after 2-4hr obs
  • D/c pt if head CT normal (delayed deterioration after normal CT is near zero)
  • Dispo decision for nondisplaced fx w/o intracranial injury should be made w/ neurosx

See Also

GCS (Peds)

Concussion

Skull Fracture

Abuse (Nonaccidental Trauma)

Head Trauma (Adult)


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

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