Head Injury (cont.)

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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 5/11/2015


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