Pediatric minor head trauma: indications for computed tomographic scanning revisited

Area of Science:

• Pediatric Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Indications for computed tomographic (CT) scanning in minor pediatric head trauma are subjective.
• Intracranial injury (ICI) risk factors in children with mild head trauma and normal neurologic exams require definition.

Purpose of the Study:

• To determine the incidence of ICI in pediatric patients with minor head trauma and normal neurologic status.
• To identify risk factors for ICI in this patient population.

Main Methods:

• Retrospective review of 569 blunt trauma patients (<16 years) with Glasgow Coma Scale (GCS) scores of 14 or 15 who underwent head CT.
• Analysis of 429 patients with known loss of consciousness (LOC) status for mechanism, age, injury severity, LOC, GCS, associated injuries, and CT findings.

Main Results:

• 14% of patients (62/429) with GCS 14-15 had ICI.
• Neither LOC nor GCS score of 14 reliably predicted ICI.
• Skull fractures and superficial craniofacial injuries were poor predictors of ICI, with 45% and 14% of ICI patients lacking these findings, respectively.

Conclusions:

• Normal neurologic exams and maintained consciousness do not rule out significant ICI in pediatric trauma.
• A liberal CT scanning policy is advised for pediatric patients with high-risk injury mechanisms, irrespective of initial neurologic status.