Gessler, Peter

RERO DOC Digital Library

Eur J Pediatr (2006) 165: 141DOI 10.1007/s00431-005-0020-0EDITORIALPeter GesslerEvaluation of pediatric head trauma in the emergency departmentReceived: 5 August 2005 / Accepted: 8 August 2005 / Published online: 26 November 2005# Springer-Verlag 2005Head trauma is one of the most common childhood injuries.More than 80% of these injuries are mild, but traumaticbrain injury is the leading cause of death due to trauma inchildren. Skull radiographs and computed tomography(CT) can accurately identify fractures and intracranialcomplications, respectively. Nevertheless, their indiscrim-inate use wastes resources and raises costs. Guidelines havebeen published for the management of minor closed headinjury in children 2–20 years of age [1, 6] and for infantsless than 2 years old [6, 9]. Acute evaluation of the head-injured child requires careful history-taking with a focus onthe mechanism and biomechanics of the injury, and aphysical examination that includes a complete neurologicalexamination. Issues in the management of the pediatricpatient with head trauma include the need for cranial CT,hospitalization, outpatient follow-up, and a consideration ofthe possibility of child abuse [3, 7].The study of Da Dalt et al. [4] in this issue addresseswhether clinical features of children with head trauma pre-dict the risk of intracranial injury. A total of 3,806 childrenunder the age of 16 years were enrolled in a prospectivemulticenter study in Italy. Based on the history and clinicalexamination, the children were classified into different riskcategories and consecutive management – i.e., discharge,observation, admittance to the intensive care unit, or neu-rosurgery. Intracranial injury was diagnosed on CT (79children underwent a CT, and intracranial injury was iden-tified in 22) and was assumed to be absent in the case of anuneventful course, as determined by a follow-up telephonecall (about 10 days after discharge), or the lack of a re-admission to hospital. The large majority of children hadminor head trauma with asymptomatic presentation or witha history of only temporary loss of consciousness. Thisstudy emphasizes the practice that CT is rarely necessary inthese children, but – and most importantly – only aftercareful clinical evaluation and a knowledge of the riskfactors for intracranial injury [2, 5, 6, 8].References1. American Academy of Pediatrics (1999) The management ofminor closed head injury in children. Committee on qualityimprovement, American academy of pediatrics, commission onclinical policies and research, and American academy of familyphysicians. Pediatrics 104:1407–14152. Arbogast KB, Margulies SS, Christian CW (2005) Initialneurologic presentation in young children sustaining inflictedand unintentional fatal head injuries. Pediatrics 116:180–1843. Berger RP, Adelson PD (2005) Evaluation and management ofpediatric head trauma in the emergency department: currentconcepts and state-of-the-art research. Clin Pediatr Emerg Med6:8–154. Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G,Pavanello L, Valent F, Barbone F Predictors of intracranialinjuries in children after blunt head trauma. Eur J Pediatr5. Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J,Sharpin C, Mackway-Jones K (2004) A meta-analysis ofvariables that predict significant intracranial injury in minorhead trauma. Arch Dis Child 89:653–6596. Kamerling SN, Lutz N, Posner JC, Vanore M (2003) Mildtraumatic brain injury in children: practice guidelines foremergency department and hospitalized patients. Pediatr EmergCare 19:431–4407. Keenan HT, Runyan DK, Marshall SW, Nocera MA, MertenDF (2004) A population-based comparison of clinical andoutcome characteristics of young children with serious inflictedand noninflicted traumatic brain injury. Pediatrics 114:633–6398. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA,Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW,Kuppermann N (2004) Does an isolated history of loss ofconsciousness or amnesia predict brain injuries in children afterblunt head trauma? Pediatrics 113:e507–e5139. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C,Jaffe D, Lewis RJ, Luerssen TG, Schunk J (2001) Evaluationand management of children younger than two years old withapparently minor head trauma: proposed guidelines. Pediatrics107:983–993P. Gessler (*)Division of Pediatric Intensive Care Medicine & Neonatology,University Children’s Hospital,Steinwiesstr. 75,8032, Zurich, Switzerlande-mail: peter.gessler@kispi.unizh.chTel.: +41-44-2667111Fax: +41-44-2667168

Evaluation of pediatric head trauma in the emergency department

http://doc.rero.ch/record/313577/files/431_2005_Article_20.pdf

Evaluation of pediatric head trauma in the emergency department

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library