Head Trauma for the Pediatrician

PEDIATRICS ◽  
1978 ◽  
Vol 62 (5) ◽  
pp. 819-825
Author(s):  
Harvey S. Singer ◽  
John M. Freeman
Keyword(s):  
Head Trauma ◽  
Surgical Intervention ◽  
Early Recognition ◽  
Skull Fracture ◽  
Trauma Management ◽  
Minor Head Trauma ◽  
X Ray ◽  
Neurologic Function ◽  
Optimal Approach

A physician's concern about continued or progressive alteration in consciousness or neurologic function will result in the early recognition of head trauma complications that require medical or surgical intervention. The role of the pediatrician following "minor" head trauma is to serve as the overseer, coordinating observations and providing informed decisions on the necessity of additional medical or diagnostic requirements. This article provides an approach to handling the patient with mild head trauma based upon our experiences and interpretations of the literature. In conclusion, we emphasize the following points: (1) patients with head trauma, especially if associated with loss of consciousness, should be examined and subsequently evaluated by reliable observers; (2) skull x-ray films rarely provide information that affects medical management; (3) deterioration in the patient's clinical condition demands consultation and appropriate neuroradiologic studies; (4) the presence of a seizure or basilar skull fracture does not in itself necessitate therapy; and (5) continued evaluation of head trauma management is required to determine the optimal approach.

Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents

2021 ◽  
pp. 000992282110096
Author(s):  
Hasan Aldinc ◽  
Cem Gun ◽  
Serpil Yaylaci ◽  
Erol Barbur
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Positive Impact ◽  
Cranial Computed Tomography ◽  
Sufficient Information ◽  
Minor Head Trauma ◽  
Computed Tomography Imaging ◽  
Factors Affecting ◽  
X Ray

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

scholarly journals Diagnostic and Clinical Management of Skull Fractures in Children

2016 ◽  
Vol 6 ◽  
pp. 47
Author(s):  
Christoph Arneitz ◽  
Maria Sinzig ◽  
Günter Fasching
Keyword(s):  
Hospital Stay ◽  
Head Trauma ◽  
Clinical Management ◽  
Skull Fracture ◽  
Neurological Symptoms ◽  
Ct Scans ◽  
Skull Fractures ◽  
X Rays ◽  
Minor Head Trauma ◽  
The Mean

Objective: The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma. Methods: We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period. Results: In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days. Conclusions: Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

scholarly journals Endovascular Treatment of Traumatic Intracranial Aneurysm in an Infant

2003 ◽  
Vol 9 (2) ◽  
pp. 199-204 ◽  
Author(s):  
B. Kim ◽  
S.-K. Lee ◽  
K.G. terBrugge
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Anterior Communicating Artery ◽  
Delayed Presentation ◽  
Minor Head Trauma ◽  
Traumatic Aneurysm

Traumatic intracranial aneurysms in children are rare and mostly related to skull fracture or rapid decelerating closed head injury. We report the case of an infant who developed intracranial aneurysm after minor head trauma and managed by endovascular treatment. A seven-month-old infant presented with delayed intracranial hemorrhage following minor head trauma. Cerebral angiography disclosed a multilobulated fusiform aneurysm involving the right anterior cerebral artery (ACA) distal to the anterior communicating artery. Endovascular treatment of the aneurysm was performed and the infant made an excellent recovery during six months clinical and radiological follow-up. Delayed presentation of intracranial hemorrhage with acute deterioration in the infant after head trauma warrants angiography for proper diagnosis and management of the traumatic aneurysm, which has a high mortality rate after rupture and rebleeding. Endovascular treatment of traumatic aneurysm is feasible in infants, and occlusion of distal intracranial arterial aneurysms can be safely and precisely achieved using current coil technology.

Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?

2009 ◽  
Vol 16 (3) ◽  
pp. 150-152 ◽  
Author(s):  
Victoria Trenchs ◽  
Ana I. Curcoy ◽  
Marta Castillo ◽  
Josep Badosa ◽  
Carles Luaces ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Skull Fracture ◽  
Cranial Ultrasound ◽  
Minor Head Trauma

scholarly journals Abusive head trauma: an epidemiological and cost analysis

2016 ◽  
Vol 18 (5) ◽  
pp. 542-549 ◽  
Author(s):  
Scott Boop ◽  
Mary Axente ◽  
Blakely Weatherford ◽  
Paul Klimo
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Surgical Intervention ◽  
Local Population ◽  
Skull Fracture ◽  
Abusive Head Trauma ◽  
Hospital Charges ◽  
Neurosurgical Procedures ◽  
Initial Hospitalization ◽  
Grade Iii

OBJECTIVE Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges. METHODS All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified. AHT was defined as skull fracture or intracranial hemorrhage in a child under the age of 5 years with a suspicious mechanism or evidence of other intentional injuries, such as retinal hemorrhages, old or new fractures, or soft-tissue bruising. Injuries were categorized as Grade I (skull fracture only), Grade II (intracranial hemorrhage or edema not requiring surgical intervention), or Grade III (intracranial hemorrhage requiring intervention or death due to brain injury). RESULTS Two hundred thirteen AHT cases were identified. The demographics of the study population are similar to those reported in the literature: the majority of the patients involved were 6 months of age or younger (55%), male (61%), African American (47%), and publicly insured (82%). One hundred one neurosurgical procedures were performed in 58 children, with the most common being bur hole placement for treatment of subdural collections (25%) and decompressive hemicraniectomy (22%). The annual incidence rate rose from 2009 (19.6 cases per 100,000 in the population under 5 years of age) to 2014 (47.4 cases per 100,000) and showed seasonal peaks in January, July, and October (6-year average single-month incidence, respectively, 24.7, 21.7, and 24.7 per 100,000). The total hospital charges were $13,014,584, with a median cost of $27,939. Treatment costs for children who required surgical intervention (i.e., those with Grade III) were up to 10 times those of children with less severe injuries. CONCLUSIONS In the authors' local population, victims of AHT are overwhelmingly infants, are more often male than female, and are disproportionately from lower socioeconomic ranks. The incidence is increasing and initial hospitalization charges are substantial and variable. The authors introduce a simple 3-tiered injury classification scheme that adequately stratifies length of hospital stay and cost.

scholarly journals Ischaemic colitis: practical challenges and evidence-based recommendations for management

2019 ◽  
Vol 12 (1) ◽  
pp. 44-52
Author(s):  
Alex Hung ◽  
Tom Calderbank ◽  
Mark A Samaan ◽  
Andrew A Plumb ◽  
George Webster
Keyword(s):  
Surgical Intervention ◽  
Early Recognition ◽  
Imaging Modality ◽  
Severe Disease ◽  
Treatment Strategies ◽  
Evidence Based ◽  
Significant Heterogeneity ◽  
Ischaemic Colitis ◽  
Intravenous Contrast ◽  
Optimal Approach

Ischaemic colitis (IC) is a common condition with rising incidence, and in severe cases a high mortality rate. Its presentation, severity and disease behaviour can vary widely, and there exists significant heterogeneity in treatment strategies and resultant outcomes. In this article we explore practical challenges in the management of IC, and where available make evidence-based recommendations for its management based on a comprehensive review of available literature. An optimal approach to initial management requires early recognition of the diagnosis followed by prompt and appropriate investigation. Ideally, this should involve the input of both gastroenterology and surgery. CT with intravenous contrast is the imaging modality of choice. It can support clinical diagnosis, define the severity and distribution of ischaemia, and has prognostic value. In all but fulminant cases, this should be followed (within 48 hours) by lower gastrointestinal endoscopy to reach the distal-most extent of the disease, providing endoscopic (and histological) confirmation. The mainstay of medical management is conservative/supportive treatment, with bowel rest, fluid resuscitation and antibiotics. Specific laboratory, radiological and endoscopic features are recognised to correlate with more severe disease, higher rates of surgical intervention and ultimately worse outcomes. These factors should be carefully considered when deciding on the need for and timing of surgical intervention.

Vomito nel trauma cranico e ondansetron: quali rischi e quali possibili benefici?

2020 ◽  
Vol 23 (10) ◽  
pp. 252-255
Author(s):  
Angela Troisi ◽  
Alessandra Iacono ◽  
Camilla Lama ◽  
Federico Marchetti
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Head Trauma ◽  
Skull Fracture ◽  
Sampling Period ◽  
Common Symptom ◽  
Minor Head Trauma ◽  
Intracranial Injury ◽  
Prospective Cohort Studies

In children minor head trauma is one of the most frequent reasons for presentation to emergency departments and clinicians’ main goal is the prompt identification of any traumatic brain injury that requires immediate treatment. Vomiting is a common symptom after a head trauma at any age, but the incidence of traumatic brain injury without other symptoms and/or signs of head injury is infrequent. This article evaluates a review recently published in the literature on the possibility and risks of administering ondansetron in paediatric patients with vomiting after minor head trauma. The review suggests that there is no association between ondansetron administration and the risk of masking a serious intracranial injury or skull fracture. Furthermore, studies show a significant increase in the use of the drug in the context of head trauma over the course of the sampling period. However, the studies have limitations, so the results should be interpreted with caution, waiting for multicentre and prospective cohort studies.

scholarly journals Indications for computed tomography use and frequency of traumatic abnormalities based on real-world data of 2405 pediatric patients with minor head trauma

2021 ◽  
Vol 12 ◽  
pp. 321
Author(s):  
Yuhei Michiwaki ◽  
Naoki Maehara ◽  
Nice Ren ◽  
Yosuke Kawano ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Altitude ◽  
Head Trauma ◽  
Medical Records ◽  
Pediatric Patients ◽  
Skull Fracture ◽  
Minor Head Trauma ◽  
Real World Data ◽  
Traumatic Intracranial Hemorrhage ◽  
Gcs Score

Background: In pediatric patients with minor head trauma, computed tomography (CT) is often performed beyond the scope of recommendations that are based on existing algorithms. Herein, we evaluated pediatric patients with minor head trauma who underwent CT examinations, quantified its frequency, and determined how often traumatic findings were observed in the intracranial region or skull. Methods: We retrospectively reviewed the medical records and neuroimages of pediatric patients (0–5 years) who presented at our hospital with minor head trauma within 24 h after injury. Results: Of 2405 eligible patients, 1592 (66.2%) underwent CT examinations and 45 (1.9%) had traumatic intracranial hemorrhage or skull fracture on CT. No patient underwent surgery or intensive treatment. Multivariate analyses revealed that an age of 1–5 years (vs. <1 year; P < 0.001), Glasgow Coma Scale (GCS) score of 14 (vs. a score of 15; P = 0.008), sustaining a high-altitude fall (P < 0.001), using an ambulance (P < 0.001), and vomiting (P < 0.001) were significantly associated with the performance of CT examination. In addition, traumatic abnormalities on CT were significantly associated with the combination of an age of under 1 year (P = 0.042), GCS score of 14 (P < 0.001), and sustaining a high-altitude fall (P = 0.004). Conclusion: Although slightly broader indications for CT use, compared to the previous algorithms, could detect and evaluate minor traumatic changes in pediatric patients with minor head trauma, over-indications for CT examinations to detect only approximately 2% of abnormalities should be avoided and the indications should be determined based on the patient’s age, condition, and cause of injury.

scholarly journals Over Use of Ionisation Radiation Imaging With Paediatric Head Trauma

2020 ◽  
Author(s):  
Ahmad Gharaibeh ◽  
Mahmoud Gharaibeh ◽  
Ahmed Alwadiya ◽  
Robert Cellar ◽  
Antonia Lackova ◽  
...  
Keyword(s):  
Head Trauma ◽  
Age Groups ◽  
Trauma Management ◽  
Radiographic Images ◽  
Intracranial Haematoma ◽  
X Ray ◽  
Radiation Imaging ◽  
Paediatric Patients ◽  
Paediatric Age ◽  
Head Area

Abstract Purpose: Is to determinate the incidence of paediatric head trauma age 0-17 years in our region in central Europe and the number of radiographic images done for paediatric patients to make a data base for further researches, to be effective in investigating, controlling, and preventing head trauma in our population and to study the real need of radiographic images: Methods: This is a retrospective study from the records of children with head trauma seen at the trauma clinics during the year 2018 Results: There were 3261 attendees recorded in paediatric age groups 0-17 years in 2018. 1168 paediatric patients presented with trauma to the head. 831 (36%) with simple injuries of the head, 295 (23.3%) with wounds in head area, 17 (1.5%) children had fractures, 23 (2%) had concussion and 2 (0.2%) patients had intracranial haematoma. 1097 (93.9%) children with head trauma were imaged by X ray (1032 patients) and CT scan (65 patients) in accordance with local guidelines for head trauma management. The percentage of patients in need of radiation is only 3.42%.Conclusion: Most head trauma in children was minor and not associated with brain injury. The radiation is over used in diagnosis of paediatric head trauma

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