Head trauma (peds)

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
• 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