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Minimal head trauma in children revisited: is routine hospitalization required?
S P Roddy1, S M Cohn, B A Moller
1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Children with normal neurological exams and head CT scans after minor head trauma do not require hospitalization. This avoids unnecessary costs and allows for home discharge with parental supervision.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Outcomes Research
Background:
- Occult head injuries in children often lead to routine hospitalization.
- Current practice involves admission even with normal central nervous system (CNS) and computed tomographic (CT) scan results.
Purpose of the Study:
- To determine the incidence of significant CNS morbidity in children with occult head injury.
- To evaluate the necessity of hospital admission for children with minimal head trauma and normal initial evaluations.
Main Methods:
- Retrospective review of children admitted to a level I trauma center with suspected closed head injury.
- Inclusion criteria: Glasgow Coma Scale of 15, normal neurologic exam, and normal head CT scan.
- Exclusion criteria: Associated injuries requiring admission. Endpoints included CNS exam deterioration, new CT findings, and prolonged hospital stay.
Main Results:
- Sixty-two children (mean age 7 years) were studied; 65% were male.
- Mean length of stay was 1.2 days; 15% experienced prolonged hospitalization.
- No child developed significant CNS sequelae requiring admission; total charges were $177,874.
Conclusions:
- Children with normal CNS exams and head CT scans after occult head injury are not at high risk for significant CNS sequelae.
- Discharge with parental supervision is a safe alternative to unnecessary hospitalization.
- This approach can reduce healthcare costs associated with pediatric head trauma evaluations.
Objective:
Children with a question of occult head injury are routinely hospitalized despite having both normal central nervous system (CNS) and computed tomographic (CT) scan examinations. We determined the incidence of significant CNS morbidity after occult head injury to determine whether or not hospital admission was necessary in children after minimal head trauma.
Methods:
We reviewed the records of children admitted to a level I trauma center with a question of closed head injury, an initial Glasgow Coma Scale equal to 15, a normal neurologic exam, and a normal head CT scan. Children with associated injuries requiring admission were excluded. The endpoints were deterioration in CNS exam, new CT findings, and the need for a prolonged hospital stay.
Results:
Sixty-two patients were studied with a mean age of 7 years (range, 1 month to 15 years), and 65% were male. The primary mechanisms of injury were fall (45%) and vehicular crash (23%). The mean injury severity score was 4 +/- 2. The mean length of stay was 1.2 days (range, 1 to 3 days). Prolonged hospitalization occurred in 9 patients (15%). No child developed significant CNS sequelae warranting hospital admission. Total charges for these hospitalizations were $177 874.
Conclusions:
Children undergoing emergency department work-up of occult head injury, who have a normal CNS exam and a normal head CT scan, do not seem to be at risk for significant CNS sequelae. These patients can be discharged home with parental supervision and avoid unnecessary and costly hospitalization.