Overview
1~2% of Pediatric ED visits
85% of pediatric head injury classified ‘mild’
Definition
Severe: GCS <8
Moderate: GCS 9~13 Minor: GCS
13~15
Physical
examination
Scalp hematoma <2 years age : Risk of skull
fracture, ICH
Hemotympanum, Raccon eye(periorbital eccymoses),
Battle sign(Bruisig behind ears) : Skull fracture
Imagine Study
|
Expert Panel Recommendations for the
Evaluation of Head Injury in Children <2 Years of Age
|
|
High risk
|
Intermediate risk
|
Intermediate risk for skull
fracture
|
Low risk
|
|
Depressed mental status
Focal neurologic findings
Acute (<24 h) skull fracture
Basilar or depressed skull fracture
Irritability
Seizure
Vomiting >5 times in 6 h
LOC >1 min
Bulging fontanelle
|
Vomiting 3 or 4 times
LOC <1 min
Resolved lethargy or irritability
Caretaker concern about behavior
Skull fracture >24 h old
|
Significant mechanism (>1-m or 3-ft
fall, motor vehicle collision)
Large, nonfrontal scalp hematoma
Fall onto hard surface
Unwitnessed trauma
Vague history but signs or symptoms of
head trauma
|
Low-risk mechanism (<1-m or 3-ft
fall)
Asymptomatic, normal examination
findings
>2 h since injury
Older age (>12 mo)
|
|
Recommendation
|
Recommendation
|
Recommendation
|
Recommendation
|
|
CT scan
|
CT or observe 4-6h
|
CT or observe 4-6h or X-ray
|
No imaging
|
|
Pediatric
Emergency Care Applied Research Network Low-Risk Criteria for Infants and
Children with Minor Head Injury
|
|
Age group
|
Low-risk criteria
|
Sensitivity
|
NPV
|
|
<2 years
|
Normal
mental status, No scalp hematoma except frotal
LOC <5s,
No severe mechanism, No palpable skull fracture ,Normal behavior per parent
|
100%
|
100%
|
|
>2 years
|
Normal mental status, No LOC, No vomiting,
Nonsevere mechanism, no sign of basilar skull fracture, no severe HA
|
96.8%
|
99.95%
|
Disposition & Follow up
|
Asymptomatic infants and children (e.g., not vomiting, normal neurologic
and mental status examinations) < 2 to 4 hours postinjury can safely be
discharged.
*Instruction: lethargy, irritability, focal deficits, or
more vomiting in 24 hours
