Related Experiment Video
Updated: Aug 12, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Mandatory admission after isolated mild closed head injury in children: is it necessary?
J Adams1, C Frumiento, L Shatney-Leach
1Division of Pediatric Surgery, The University of Vermont College of Medicine, Burlington, VT 05401, USA.
Insights
Routine hospital admission for children with mild head injuries, normal CT scans, and Glasgow Coma Score (GCS) of 15 may not be necessary. This study suggests a potential for reduced admissions in pediatric concussion cases.
Area of Science:
- Pediatric Traumatology
- Neurology
- Emergency Medicine
Background:
- Children with mild closed head injuries (concussion) and normal neurological exams are often admitted for observation.
- Recent evidence questions the necessity of routine admission for these pediatric patients.
Purpose of the Study:
- To evaluate the length of stay, procedures, and complications in children with mild closed head injuries.
- To determine if routine admission is necessary for pediatric patients with concussion, negative CT scans, and normal neurological findings.
Main Methods:
- Review of the National Pediatric Trauma Registry-Phase II (October 1988-January 1996).
- Inclusion criteria: age <18, isolated closed head injury, blunt trauma, admission Glasgow Coma Score (GCS) of 15.
- Variables analyzed: age, gender, injury mechanism, length of stay, procedures, and outcomes.
Main Results:
- 1,033 children met the study criteria; average age 8.3 years, 61.9% male.
- Falls, sports, and motor vehicle crashes were common injury mechanisms.
- Average length of stay was 1.19 days; 60 children were not admitted. No neurosurgical interventions were required, and all patients were discharged alive.
Conclusions:
- Routine admission may not be necessary for children with isolated mild closed head injuries, negative CT scans, and normal neurological findings.
- Findings support the need for a prospective randomized trial to confirm the non-necessity of routine admissions.
Background/Purpose:
Children with closed head injuries diagnosed as concussion alone or concussion with brief loss of consciousness are admitted routinely for observation despite a normal central nervous system finding, negative computed tomography (CT) scan, and a Glasgow Coma Score (GCS) of 15. Recent studies have questioned the necessity of such an admission. The purpose of this study was to review a large pediatric database and study the length of stay as well as any required procedures or complications in these children. The hypothesis was that routine admission is unnecessary in this population.
Methods:
The National Pediatric Trauma Registry-Phase II was reviewed for the period from October 1988 to January 1996. Entry criteria included age less than 18 and an isolated closed head injury after blunt trauma with an admission GCS of 15. Variables studied included age, gender, mechanism of injury, length of stay, procedures, and outcome.
Results:
A total of 1,033 children met criteria for this study. The average age was 8.3 years. Males predominated at 61.9%. Falls, sports, and motor vehicle crashes were the most common mechanisms of injury. The average length of stay was 1.19 days, and 60 children were not admitted. A total of 583 children had no procedures performed, whereas 386 received a CT scan, and 148 had x-rays. None required neurosurgical intervention, and all were discharged alive.
Conclusion:
These findings indicate that routine admission may not be necessary for children with isolated mild closed head injuries with a negative CT scan and a normal neurologic finding and allows for a prospective randomized trial to confirm this.
Related Concept Videos
01:22Bacterial Meningitis I: Introduction
01:28Traumatic Brain Injury l: Introduction
01:14Increased Intracranial Pressure l: Introduction
01:29Increased Intracranial Pressure ll: Pathophysiology