Related Experiment Videos
Treatment of children with posttraumatic transient loss of consciousness
Insights
Pediatricians vary in hospitalizing children with brief loss of consciousness after head trauma. Key admission criteria include abnormal vital signs, skull fractures, and signs of abuse, guiding treatment decisions for these head injury cases.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Neurology
- Trauma Care
Background:
- Treatment guidelines for asymptomatic children with brief loss of consciousness (LOC) due to blunt head trauma are inconsistent.
- Anecdotal recommendations and significant practice variations exist among healthcare providers.
- A need exists to define current practices and identify criteria influencing hospitalization decisions.
Purpose of the Study:
- To determine the frequency of routine hospitalization for observation in children with uncomplicated LOC.
- To identify specific clinical criteria that prompt hospitalization for these pediatric patients.
- To understand the range of current practices in managing pediatric head trauma with LOC.
Main Methods:
- Nationwide questionnaire survey distributed to 957 pediatricians across five physician groups.
- Data collected on hospitalization frequency and specific admission criteria for children with uncomplicated LOC.
- Analysis of responses from pediatric emergency room directors, chief residents, academic child neurologists, private practice child neurologists, and private practice pediatricians.
Main Results:
- Hospitalization rates for children with LOC varied significantly by physician group, ranging from 29% (academic child neurologists) to 44% (pediatric emergency room directors).
- Common admission criteria among physicians not routinely hospitalizing included abnormal vital signs (97-100%), skull fracture (96-100%), and suspicion of child abuse (93-100%).
- Other significant factors influencing admission were altered level of consciousness, unreliable home caretaker, vomiting, and duration of LOC.
Conclusions:
- Significant variability exists in the management of children experiencing brief LOC after blunt head trauma.
- Specific clinical indicators, such as abnormal vital signs, skull fractures, and suspected abuse, are consistently used to guide hospitalization decisions.
- Standardized criteria could improve consistency in treating pediatric head injuries involving loss of consciousness.
Abstract:
Recommendations for the treatment of asymptomatic children who have had a brief period of loss of consciousness due to blunt head trauma are anecdotal and vary greatly. The purpose of this study is to define the range of practice in treating children with uncomplicated loss of consciousness by determining: (1) the frequency of "routine" hospitalization for observation and (2) those criteria which, when present, result in hospitalization. A total of 957 pediatricians representing five groups of physicians responded to a nationwide questionnaire survey to determine current treatment practices for uncomplicated loss of consciousness. Of all directors of pediatric emergency rooms and pediatric chief residents, 44% routinely hospitalize all patients who have had loss of consciousness. Academic child neurologists and child neurologists in private practice hospitalize these patients least frequently, 29% and 31%, respectively (P less than 0.05). Of pediatricians in private practice, 38% admit all children with loss of consciousness. Pediatricians from all groups who do not routinely hospitalize all children with uncomplicated loss of consciousness showed similarity in the criteria they use for admission. These variables include: abnormal vital signs (97% to 100%), skull fracture (96% to 100%), suspicion of child abuse (93% to 100%), observation of a change in level of consciousness (92% to 99%), unreliable caretaker at home (91% to 98%), vomiting (90% to 99%), history of a change in level of consciousness (88% to 100%), duration of loss of consciousness (88% to 96%), seizure (77% to 94%), age of child (62% to 75%), child nearly back to normal (32% to 48%), dizziness (22% to 49%), witness of loss of consciousness not reliable (24% to 36%), headache (9% to 16%), and decision deferred to neurosurgeon (2% to 7%).(ABSTRACT TRUNCATED AT 250 WORDS)