Evaluation of Decision Rules for Identifying Serious Consequences of Traumatic Head Injuries in Pediatric Patients

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

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Urban–rural differences in pediatric traumatic head injuries: A prospective nationwide study

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s2034 ◽

2008 ◽

Vol Volume 3 ◽

pp. 935-941 ◽

Cited By ~ 8

Author(s):

Jonas Halldorsson

Keyword(s):

Head Injuries ◽

Nationwide Study ◽

Traumatic Head

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Famous head injuries of the first aerial war: deaths of the “Knights of the Air”

Neurosurgical FOCUS ◽

10.3171/2015.4.focus15109 ◽

2015 ◽

Vol 39 (1) ◽

pp. E5

Author(s):

Prateeka Koul ◽

Christine Mau ◽

Victor M. Sabourin ◽

Chirag D. Gandhi ◽

Charles J. Prestigiacomo

Keyword(s):

Head Injury ◽

World War I ◽

Head Injuries ◽

World War ◽

Traumatic Head Injury ◽

The Public ◽

Time Period ◽

Traumatic Head ◽

The Media

World War I advanced the development of aviation from the concept of flight to the use of aircraft on the battlefield. Fighter planes advanced technologically as the war progressed. Fighter pilot aces Francesco Baracca and Manfred von Richthofen (the Red Baron) were two of the most famous pilots of this time period. These courageous fighter aces skillfully maneuvered their SPAD and Albatros planes, respectively, while battling enemies and scoring aerial victories that contributed to the course of the war. The media thrilled the public with their depictions of the heroic feats of fighter pilots such as Baracca and the Red Baron. Despite their aerial prowess, both pilots would eventually be shot down in combat. Although the accounts of their deaths are debated, it is undeniable that both were victims of traumatic head injury.

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Analysis of All-Terrain Vehicle Trauma Data: Implications for Increased Regulation and Injury Prevention

The American Surgeon ◽

10.1177/000313481708300420 ◽

2017 ◽

Vol 83 (4) ◽

pp. 348-353

Author(s):

Cathy V. Ho ◽

James R. Dunne ◽

Wesley R. Stroud ◽

Alvaro H. Fonseca ◽

Frank E. Davis ◽

...

Keyword(s):

Injury Prevention ◽

Pediatric Patients ◽

Head Injuries ◽

Prospective Data ◽

Helmet Use ◽

Closed Head Injuries ◽

Closed Head ◽

Recreational Vehicles ◽

Injured Patients ◽

Motorcycle Crashes

To determine the incidence and severity of all-terrain vehicle crashes (ATVCs) compared with motorcycle crashes (MCCs) in all critically injured patients. Prospective data were retrospectively reviewed on 1840 patients involved in ATVCs and MCCs admitted to a rural level one trauma center over 16 years. ATVC patients (n = 655) were younger (25 vs 38, P < 0.0001), more likely female (20% vs 11%, P < 0.001), less severely injured (13.5 vs 16, P < 0.0001), had similar Glasgow Coma Score (13.3 vs 13.4, p = NS), less helmet use (6% vs 69%, P < 0.0001), more closed head injuries (59.7% vs 54.3%, P < 0.05), more facial injuries (16.9% vs 12.5%, P < 0.05), and lower mortality rate (2.8% vs 5.9%, P < 0.01) compared with MCC patients (n = 1172). Pediatric patients involved in ATVC were more common (29.8% vs 4.8%, P < 0.001), had decreased helmet use (12% vs 59%, P < 0.001) and decreased mortality (3.5% vs 14.3%, P < 0.01). Further injury prevention efforts regarding helmet use and increased regulations regarding ATVCs are needed to decrease the morbidity associated with these recreational vehicles.

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The reliability of CT scan in detecting extradural hemorrhage in traumatic head injuries

Journal of Forensic Radiology and Imaging ◽

10.1016/j.jofri.2013.03.029 ◽

2013 ◽

Vol 1 (2) ◽

pp. 77-78

Author(s):

Hitesh Chawla ◽

Basant Lal Sirohiwal ◽

Rohtas Yadav ◽

Mahavir Griwan ◽

Pramod Kumar Paliwal

Keyword(s):

Ct Scan ◽

Head Injuries ◽

Traumatic Head

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Akathisia after mild traumatic head injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.11.peds09389 ◽

2010 ◽

Vol 5 (5) ◽

pp. 460-464 ◽

Cited By ~ 5

Author(s):

Atman Desai ◽

David W. Nierenberg ◽

Ann-Christine Duhaime

Keyword(s):

Head Injury ◽

Pediatric Patients ◽

Single Administration ◽

Clinical Context ◽

Traumatic Head Injury ◽

Head Ct ◽

Acute Head Injury ◽

Traumatic Head ◽

Symptom Complex ◽

Motor Restlessness

The authors describe the case of a 13-year-old boy who exhibited progressive disabling motor restlessness, torticollis, urinary symptoms, and confusion following a fall from a bicycle. The differential diagnosis of this striking symptom complex in this clinical context can be problematic. In this case, the symptoms ultimately appeared most consistent with severe akathisia resulting from a single administration of haloperidol used at an outside hospital to sedate the patient prior to a head CT scan. The literature on akathisia in pediatric patients, and especially in patients following acute head injury, is reviewed, with suggestions for an approach to these symptoms in this clinical setting.

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