Head Injury (Brain Injury)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideConcussions & Brain Injuries: Symptoms, Tests, Treatment

Concussions & Brain Injuries: Symptoms, Tests, Treatment

What is the prognosis for a head injury?

The goal for the treatment of any patient is to return to the level of function that they had prior to the injury. This maybe a challenge with head injury, and the return of function depends upon the severity of the injury to the brain.

How can a head injury be prevented?

Prevention is the best way to treat a head injury.

  • In sporting activities, the use of a helmet may help decrease the risk of injury. Similarly, wearing a helmet while riding a motorcycle or bicycle helps minimize the risk of brain injury. Seatbelts can help prevent a head injury during a motor vehicle crash.
  • Since alcohol is a risk factor for falls and other injuries, it should be used responsibly.
  • Falls are a concern in the elderly. Homes can be made less fall-prone by installing assist devices on walls and in bathrooms. Loose floor coverings such as area rugs should be avoided, since walking from one floor covering to another increases the risk of falls. If needed, canes and walkers may be helpful as walking assistive devices.

What about a head injury in infants and young children?

A minor head injury in an infant is described by the American Academy of Pediatrics as the following, "A history or physical signs of blunt trauma to the scalp, skull, or brain in an infant or child who is alert or awakens to voice or light touch."

In children and infants younger than 2 years of age, it is more difficult to assess their mental status and guidelines that work for adults do not necessarily apply to this age group. The Pediatric Emergency Care Applied Research Network (PECARN) has developed an algorithm that helps decide when a CT scan of the head might be appropriate.

For children younger than 2 years of age:

CT scan is recommended for those patients with a Glasgow Coma Scale of less than 15, altered mental status, or a palpable skull fracture.

For those with a Glasgow Coma Scale of 15 but with an occipital, temporal, or parietal hematoma (that is swelling on the back or side of the head), significant trauma, or loss of consciousness for greater than 5 seconds, or for those not acting normally according to their parents, a CT scan may be considered based upon the following:

  • physician experience,
  • multiple physical findings,
  • worsening symptoms during observation in the ER,
  • age less than 3 months, or
  • parental preference.

For all others, CT scan is not recommended.

For children older than 2 years of age:

CT scan is recommended for those patients with a Glasgow Coma Scale of less than 15, altered mental status, or a basilar skull fracture.

For patients with loss of consciousness, vomiting, severe headache, or a severe mechanism of injury, a CT scan may be considered based upon the following:

  • physician experience,
  • multiple physical findings,
  • worsening symptoms during observation in the ER, or
  • parental preference.

For all others, CT scan is not recommended.

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology

REFERENCE:

Kuppermann, N., et al. "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study." Lancet 374.9696 (2009): 1160-1170.

Medically Reviewed by a Doctor on 8/5/2016

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