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Closed head injuries in children: is hospital admission always necessary?
D L Dahl-Grove1, V T Chande, A Barnoski
1Case Western Reserve University, Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106, USA.
Insights
This study identified pediatric patients with mild head injuries and normal CT scans who could be safely monitored at home. These findings aid in determining appropriate observation levels for mild traumatic brain injuries in children.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Pediatrics
Background:
- Mild closed head injuries are common in children.
- Determining safe observation protocols for pediatric patients with mild head injuries and normal imaging is crucial.
Purpose of the Study:
- To identify a cohort of pediatric patients with mild closed head injury, no significant associated trauma, and normal head computerized tomography (CT) scans.
- To assess the safety of home observation for these selected patients by a reliable caretaker.
Main Methods:
- Retrospective chart review of pediatric emergency department (PED) and hospital course data.
- Inclusion criteria: patients aged 1-17 years with closed-head injury, Glasgow Coma Scale (GCS) ≥ 13, and normal head CT.
- Data collected from June 1991 to August 1992 at an urban university children's hospital.
Main Results:
- Sixty-two patients met inclusion criteria (mean age 8.5 years).
- Common injury mechanisms included falls and motor vehicle accidents.
- Most patients had a GCS of 15 and a low Abbreviated Injury Scale (AIS) score.
Conclusions:
- A subset of pediatric patients with mild head injury and normal head CT can be safely observed at home.
- Further research is needed to establish clear guidelines for home observation versus hospital admission.
Abstract:
The objective of this study was to identify a group of patients with mild closed head injury, lack of other significant trauma, and normal head computerized tomograph (CT), who could be safely observed at home by a reliable caretaker. Data were from a retrospective chart review of pediatric emergency department (PED) and hospital course of an urban university children's hospital. The pediatric trauma registry was used to identify patients one to 17 years old seen in the PED with closed-head injury and normal head CT between June 1991 and August 1992. A total of 746 patients with heads injury were seen in the PED, and 161 patients with closed-head injury were admitted during the study period. Sixty-two patients (mean age = 8.5 +/- 5 years) met inclusion criteria with hospital admission, mild head injury, Glasgow Coma Scale > or = 13, and normal head CT. Of the patients 63% (34) were male and 37% (23) were female, with 74% (46) African-American and 26% (16) Caucasian. The most frequent mechanisms of injury were 27% (17) fall from height (mean height = 6.7 +/- 4.6 feet) and 18% (11) passenger in a motor vehicle accident. Patients had a median Glasgow Coma Scale of 15 (mean 14.8) and median abbreviated injury score of 2 (mean = 1.8). Thirty-seven percent of patients (23) had a history of loss of consciousness (range one to five minutes) and 6% (4) had generalized tonic-clonic seizure after the injury.(ABSTRACT TRUNCATED AT 250 WORDS)