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Management of accidental minor head injuries in children: a prospective outcomes study
Mark S Dias1, Kathleen A Lillis, Carmela Calvo
1Department of Pediatrics (Division of Emergency Medicine), Center for Pediatric Quality, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, New York, USA. mdias@psu.edu
Insights
A new management strategy for children with minor head injuries, involving computerized tomography (CT) scans and emergency department observation, is safe, effective, and cost-saving. This approach avoids unnecessary hospital admissions for pediatric head trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Management
- Health Services Research
Background:
- Accidental minor head injuries are common in children.
- Traditional management often involves hospital admission, increasing costs and resource utilization.
- Evaluating alternative management strategies is crucial for optimizing pediatric care.
Purpose of the Study:
- To assess the clinical, patient/family satisfaction, and financial outcomes of a management scheme for children with minor head injuries.
- To compare outcomes of emergency department observation with overnight hospital admission.
- To determine the safety and efficacy of routine computerized tomography (CT) scans in this population.
Main Methods:
- A prospective study of 215 children (≥24 months) with minor head injuries (Glasgow Coma Scale Scores 13-15).
- Children meeting clinical and radiographic criteria underwent immediate CT scanning and emergency department observation.
- Discharge to home observation was implemented for patients without intracranial abnormalities.
Main Results:
- No child experienced clinical complications or neurological deterioration.
- Only 0.9% required reevaluation for persistent symptoms, with no intracranial abnormalities found on repeat CT.
- Universal parent satisfaction was reported, and significant cost savings were achieved compared to inpatient admission.
Conclusions:
- Routine initial CT studies and emergency department observation are safe for children with minor head injuries.
- This management scheme is well-accepted by patients and families.
- Significant cost savings can be realized by avoiding unnecessary hospitalizations.
Object:
The authors conducted a study to determine clinical, patient/family satisfaction, and financial outcomes following application of a management scheme that involves evaluation of computerized tomography (CT) scans and emergency department observation, rather than overnight admission, for children who have sustained accidental minor closed head injuries (Glasgow Coma Scale Scores 13-15) and who have met predefined clinical and radiographic criteria.
Methods:
During 18 consecutive months, all children age 24 months and older who sustained accidental minor head injuries were managed prospectively according to a standard protocol. All children meeting prospectively established clinical criteria underwent immediate CT scanning and were observed in the emergency department. Those in whom there were no intracranial radiographically demonstrated abnormalities and who met established clinical criteria were discharged to home observation. Two hundred fifteen children met the criteria for the study. Falls (53%) and motor vehicle accidents (13%) constituted the most common mechanisms of injury. Of the patients for whom information was recorded, 40% experienced a loss of consciousness and 49% had amnesia. Repeated vomiting occurred in 45%. Skull fractures were rare. No child suffered a clinical complication or neurological deterioration. Two patients (0.9%) underwent reevaluation within 48 hours for persistent symptoms; no intracranial abnormality was demonstrated in either on repeated CT scanning and both recovered uneventfully. Follow-up phone surveys in a subgroup of patients indicated universal parent satisfaction. Compared with a control group that underwent both CT scanning and were admitted to the hospital, statistically significant cost savings were realized in the cohort.
Conclusions:
A management scheme that involves routine initial CT studies and a brief period of observation in the emergency department is safe and readily accepted by patients and families and can achieve significant cost savings.
