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How should we manage children after mild head injury?
M Mandera1, T Wencel, P Bazowski
1Department of Neurosurgery, Silesian University School of Medicine, Katowice, Poland. marekman@mp.pl
Insights
Mild head injuries in children can lead to serious complications. Early CT scans and 24-hour hospital observation are recommended for all pediatric patients with mild head trauma to detect potential intracranial hematomas.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Emergency Medicine
Background:
- Mild head injuries in children present management challenges due to potential for delayed intracranial complications.
- Current diagnostic approaches may not adequately identify all at-risk pediatric patients.
- Establishing a clear clinical protocol is essential for effective management of mild head trauma in children.
Purpose of the Study:
- To identify significant factors predicting subsequent deterioration in children with mild head injuries.
- To develop a clinical protocol for managing mild head injuries in pediatric populations.
- To evaluate the efficacy of diagnostic tools in detecting intracranial complications.
Main Methods:
- Retrospective review of 166 pediatric patients with mild head trauma (Glasgow Coma Scale/Children Coma Scale scores of 13-15).
- Patients categorized into five age groups (infants to adolescents).
- Analysis of injury causes, clinical presentation, diagnostic findings (skull X-ray, CT scans), and treatment outcomes.
Main Results:
- Traffic accidents and falls were the primary causes of mild head injury.
- Neurosurgical intervention was required in 56% of cases, with subdural and epidural hematomas being the most common lesions.
- Skull fractures were present in 62% of patients, but intracranial hematomas also occurred in children without fractures.
- CT scanning revealed intracranial hematomas in a significant number of patients, even without skull fractures.
- 99% of patients achieved good or very good outcomes, with no severe disabilities or vegetative states reported.
Conclusions:
- Skull X-ray is insufficient for ruling out intracranial hematomas in children with mild head injuries.
- CT scanning is crucial for diagnosing intracranial lesions in this patient group.
- A 24-hour hospital admission for observation is recommended for all children with mild head injury due to the risk of delayed complications.
Abstract:
There are many controversies concerning the management of children after mild head injury. Most of these patients achieve a full recovery without medical or surgical intervention. A small percentage of them deteriorate owing to intracranial complications. The goal of this study was to identify significant factors that might allow the identification of patients at risk of subsequent deterioration. Its secondary goal was to establish a clinical protocol for the management of mild head injuries in children. We retrospectively reviewed the records of 166 children and adolescents with head trauma who had Glasgow Coma Scale (GCS) or Children Coma Scale (CCS) scores of 13-15 at the time of admission. The patients were divided into five age categories: babies younger than 1 year, children 1-3, 4-6, and 7-14 years old, and adolescents 15-17 years of age. The largest age group consisted of children 7-14 years old (83 cases). There was a male predominance (2:1). The main causes of injury were traffic accidents (55 cases) and falls (53 patients). Neurosurgical procedures were required in 93 of the 166 patients (56%). The most common intracranial lesion was subdural and epidural hematoma (60 cases). In 26 children (15.6%) diffuse brain swelling was the only lesion. A skull fracture was found in 103 cases and was accompanied by epidural hematoma (HED) in 19 cases (18%) and by subdural hematoma (HSD) in 12 cases (12%). However, the 63 children without a fracture also included 18 (29%) who had HSD and 11 (17%) who had HED. In our population 165 (99%) of the patients obtained a very good or good result. None was left severely disabled or in a vegetative state. One patient with GCS 13 died of an infection. We concluded that skull X-ray examination is not sufficient to rule out intracranial hematoma. We recommend CT scanning and admission to hospital for 24-h observation for all children with minor head injury, because of the risk of delayed hematoma.