Risk Factors in the Outcome of Children with Minor Head Injury

Abstract

A subset of children with minor head injury is known to develop serious neurological consequences, but identifying this subset has been difficult. In adults, multiple variables such as skull fracture, Glasgow Coma Scale score, unconsciousness, and amnesia are significant factors that determine whether to admit the patient to the hospital and the patient’s outcome. As an objective assessment of neurological function, however, the Glasgow Coma Scale has limited usefulness in children, particularly those under 36 months of age. We report our experience with 937 children having head injuries using a Glasgow Coma Scale modified for children (Children’s Coma Scale). During the 6-year study period, 791 of the 937 children (84%) sustained minor head injuries (Glasgow Coma Scale or Children’s Coma Scale score of 13, 14, or 15). The mean age of patients was 5.5 years. Males predominated over females by a 2:1 ratio. The most common cause of injury was a fall, followed by a pedestrian/motor vehicle accident. Seven hundred and thirty-nine of the 791 children were alert at the time of admission. Of these, 99 (13.4%) had lesions requiring surgery: 9 had subdural hematomas, 35 had epidural hematomas, 44 had depressed skull fractures, and 11 had other types of lesions. Two children (0.3%) with Glasgow Coma scores of 13 died after subsequent deterioration, 1 of a delayed epidural hematoma, the other of diffuse cerebral edema. Risk factors such as length of unconsciousness, presence of skull fractures, computed tomography findings, posttraumatic seizure, and Glasgow or Children’s Coma scores were evaluated for their impact on the patient’s outcome. Based on these factors, we have developed guidelines for treating children with minor head injuries.

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

“…There were only four studies 88,131,137,139 that reported neurosurgical injury as an outcome, so only very limited conclusions can be drawn and, as suggested with adults, it may be more appropriate to simply extrapolate from estimates for any ICI. The absence of radiological fracture had some value for ruling out neurosurgical injury.…”

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

“…Dietrich et al 15 reported a similar occurrence (5%) of neurologically intact children who had intracranial disorders. Hahn and McLone 21 reported a 7% incidence of mass lesions in head-injured children admitted to the hospital with GCS scores of 15. However, in a recent report by Davis et al, 22 none of the 49 neurologically intact children older than 2 years with isolated head injury had intracranial hemorrhage.…”

Technical Report: Minor Head Injury in Children

“…3,6 -9 The high estimate of 7% comes from a study in which both initial and delayed (24-hour) CT scans were obtained for most patients; how many patients were referred for care at this institution because of clinical deterioration was not noted. 8 Three unpublished studies provided prevalence estimates of intracranial injuries ranging from 4% to 10% among patients with a GCS score of 15, without focal neurologic findings, but with either a history of (brief) loss of consciousness or amnesia (J. Finkelstein, 1994; S. C. Stein, 1994; S. C. Stein, 1994).…”