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[The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study]
Joana Matias1, Sofia Almeida2, Sofia Ferrito1
1Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
Insights
Hospitalizing children with minor head injuries and careful computerized tomography (CT) scan selection is safe. This approach reduces radiation exposure without increasing risks, as significant intracranial injury was infrequent in the study.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Minor head injuries are common in children, often not leading to intracranial injury.
- Computerized tomography (CT) head scans are standard but involve radiation exposure.
- Indications for CT scans in minor head injuries lack consensus, with expectant management being a viable alternative.
Purpose of the Study:
- To compare outcomes of hospitalized children with and without CT head scans after minor head injury.
- To assess the safety and efficacy of the institution's protocol for managing minor head injuries in pediatric patients.
Main Methods:
- A retrospective longitudinal study of 206 children under 15 with minor head injuries over three years.
- Patients were divided into two groups: Group A (hospitalized with CT scan) and Group B (hospitalized without CT scan).
- Data collected included symptoms, physical examination findings, CT scan results, and patient outcomes.
Main Results:
- CT scans were performed in 39% of patients, primarily those with red flags or unfavorable hospital course.
- 43% of scanned patients had traumatic brain injury, including fractures and intracranial injuries; three required neurosurgery.
- No deaths, readmissions, or neurological sequelae were recorded; vomiting was more frequent in the non-CT group.
Conclusions:
- Hospitalization and surveillance for symptomatic minor head injuries in children, without concerning physical findings, appear safe.
- Careful patient selection for CT scans effectively reduced the number of examinations and radiation exposure.
- The study supports a selective approach to CT imaging in pediatric minor head injuries.
Introduction:
Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution's practice protocol.
Material And Methods:
Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).
Results:
Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.
Discussion:
Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.
Conclusion:
The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation.
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