Management of minor head trauma
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Published on: September 25, 2014
1Harbor/UCLA Medical Center, Torrance 90509.
Insights
Minor head trauma in children rarely leads to epidural hematoma. Children with brief loss of consciousness (LOC) and post-traumatic amnesia (PTA) may be safely observed at home if caretakers are reliable.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Pediatrics
Background:
- Minor head trauma is a common pediatric presentation.
- Epidural hematoma is a rare but serious complication.
- Current management often involves hospital admission for observation.
Purpose of the Study:
- To evaluate criteria for safe home observation of children with minor head trauma.
- To identify predictors of serious intracranial injury in pediatric patients.
Main Methods:
- Literature review.
- Retrospective chart review of 143 pediatric patients (0-16 years) admitted for minor head trauma.
- Analysis of clinical variables including duration of loss of consciousness (LOC) and post-traumatic amnesia (PTA).
Main Results:
- LOC and PTA are indicators of head trauma severity, with exceptions in children under 2 years.
- Linear skull fractures did not change medical management.
- Children with LOC ≤ 5 min, PTA < 60 min, and normal neurological exam were candidates for home observation.
Conclusions:
- Specific clinical criteria can identify low-risk pediatric patients with minor head trauma suitable for home observation.
- This approach may reduce unnecessary hospital admissions.
- Reliable caretakers and available medical access are crucial for safe home management.
Abstract:
Minor head trauma with loss of consciousness (LOC) results in large numbers of admissions each year in anticipation of the rare complication of epidural hematoma. The literature was reviewed and the records of 143 children aged 0-16 years admitted to Harbor/UCLA Medical Center with the diagnosis of minor head trauma were examined. Duration of LOC and post-traumatic amnesia (PTA) are good indicators of degree of head trauma, except in children under 2 years. Linear skull fractures do not alter medical management. Children with LOC less than or equal to 5 min, PTA less than 60 min, and normal neurologic examination can be observed at home by reliable caretakers provided access to further medical care is readily available.
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