Clinical Predictors of Severe Head Trauma in Children

Hennes, Halim M.; Lee, Martha; Smith, Douglas S.; Sty, John R.; Losek, Joseph D.

doi:10.1001/archpedi.1988.02150100039021

Cited by 37 publications

(28 citation statements)

References 12 publications

(4 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hennes et al 5 retrospectively studied 55 children and identified altered mental status, evidence of increased intracranial pressure, seizures, and focal deficits as predictors of intracranial injury. Rivara et al 20 retrospectively studied 98 children, and described an abnormal Glasgow Coma Scale (GCS) score, altered consciousness, and focal neurologic abnormality as predictors of intracranial injury.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, scalp abrasions, lacerations, contusions, and hematomas as the only physical findings in older children and adults have not been associated with intracranial injury. 5,18 Children younger than 1 year, however, often have been excluded in prior studies examining clinical features predictive of intracranial injury. In addition, one study has suggested that scalp hematomas in children younger than 2 years may be predictive for serious injury.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4] Head injuries in children account for 250 000 hospital admissions each year, whereas nearly 5 million children present to hospital emergency departments seeking evaluation and care of head injuries. 5,6 The morbidity and mortality associated with significant intracranial injury may be ameliorated by early diagnosis and treatment. [7][8][9][10] Despite the frequent occurrence of head injury in children, diagnostic strategies differ among individuals and institutions.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

et al. 1997

View full text Add to dashboard Cite

ABSTRACT. Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma.Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head computed tomography, and data forms including mechanism of injury, symptoms, and physical findings were completed for each child.Results. Intracranial injury occurred in 27 children (8%), whereas 50 (16%) had skull fractures. Of those with intracranial injury, 16 (59%) had normal mental status and no focal abnormalities, and 1 of those 16 required surgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma without other symptoms. Findings not significantly associated with intracranial injury were scalp contusion, laceration, hematoma, abrasion, headache, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consciousness for more than 5 minutes, altered mental status, and focal neurologic abnormality.Conclusions. Intracranial injury may occur with few or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study. Pediatrics 1997;99(5). URL: http://www.pediatrics.org/cgi/content/full/99/5/e11; brain injuries, head injuries, skull fractures, computed tomography, radiography.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

et al. 1997

View full text Add to dashboard Cite

show abstract

“…Among these articles, however, 3 included patients with more severe symptoms or findings than specified by the guideline case description (including Glasgow coma scale [GCS] scores as low as 13), [1][2][3][4] and 1 included trivial abnormalities on CT as the principal outcome measure. 5 Among those studies restricting their subjects to GCS scores of 15, and considering abnormal findings to be subdural, extradural, or intracerebral hematomas, ranges of the prevalence of intracranial injury ranged from 0% to 7%.…”

Section: Risk Of Intracranial Injurymentioning

confidence: 99%

“…Two studies indicated that among patients with a GCS score of 15, normal neurologic examinations, no history of loss of consciousness or amnesia, no vomiting, headache, or subtle changes in mental status, there were no abnormal CT scan findings. 1,7 One additional case series (49 children) found that no child with a GCS of 15, a completely normal neurologic examination, and no trauma aside from the head injury experienced an intracranial lesion, even with a history of loss of consciousness or amnesia. 9 The upper limits for the 95% confidene interval for this estimate is 6%, and the analysis that identified this group of predictors is exploratory; no confirmatory analyses were undertaken in a second dataset.…”

Section: Risk Of Intracranial Injurymentioning

confidence: 99%

Technical Report: Minor Head Injury in Children

Homer¹,

Kleinman²

1999

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidencebased recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/ cgi/content/full/104/6/e78; head trauma, imaging, literature review.ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow coma scale. Minor head trauma affecting a child is a common reason for medical consultation and evaluation. No consensus exists concerning the appropriate diagnostic assessment of such children. Previous surveys of physicians indicated significant variation in practice, and examination of hospitalization rates shows substantial regional variation for this condition. The American Academy of Pediatrics, in coordination with the American Academy of Family Physicians, launched an initiative to develop a clinical practice guideline to reduce variation and improve the quality of care of children with minor head trauma.This report provides the technical information on the literature concerning minor head t...

show abstract