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Minor head trauma in children is common, but current research lacks a strong evidence base for clinical guidelines. More consistent definitions and assessments are needed for better management strategies.
Area of Science:
- Pediatrics
- Neurology
- Evidence-Based Medicine
Background:
- Minor head trauma is a frequent reason for pediatric medical consultations.
- Existing literature lacks sufficient evidence for robust clinical practice guidelines.
Purpose of the Study:
- To systematically review the literature on minor head trauma in children.
- To inform the development of clinical practice guidelines for the American Academy of Pediatrics.
Main Methods:
- Systematic literature search of Medline and Health databases (1966-1997).
- Inclusion of articles on head trauma in infants, children, and adolescents.
- Abstract review for relevance to mild head trauma, with data abstraction and summarization.
Main Results:
- 108 articles were abstracted from over 1000 identified sources.
- Prevalence of intracranial injury ranged from 0% to 7% in children with mild head trauma.
- Computed tomography (CT) scans demonstrated higher sensitivity and specificity for intracranial abnormalities compared to skull radiographs.
Conclusions:
- The current body of literature is insufficient for evidence-based recommendations on managing mild head trauma in children.
- Inconsistent definitions and the need for multisite assessments hinder clarification in this field.
Unlabelled:
Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.
Methods:
Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.
Results:
A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.
Conclusions:
The literature on mild head trauma does not provide a sufficient scientific basis for evidence-based recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field.