Clinical Pediatric Emergency Medicine
Volume 6, Issue 1 , Pages 8-15 , March 2005

Evaluation and Management of Pediatric Head Trauma in the Emergency Department: Current Concepts and State-of-the-Art Research

  • Rachel Pardes Berger, MD, MPH

      Affiliations

    • Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213
    • Corresponding Author InformationReprint requests and correspondence: Rachel Berger, MD, MPH Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213.
  • ,
  • P. David Adelson, MD

      Affiliations

    • Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213

References 

  1. National Center for Injury Prevention and Control. Traumatic brain injury in the United States: a report to Congress. Atlanta (GA): Centers for Disease Control and Prevention; 1999;
  2. Centers for Disease Control and Prevention. 2000 National Ambulatory Medical Care Survey, Emergency Department File 2002. Hyattsville (MD): National Center for Health Statistics; 2002;
  3. Kraus JF, Rock A, Hemyari P. Brain injuries among infants, children, adolescents, and young adults. Am J Dis Child. 1990;144:684–691
  4. Schutzman SA, Barnes P, Duhaime AC, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics. 2001;107:983–993
  5. Durham S, Clancy R, Leuthardt E, et al. CHOP Infant Coma Scale (“infant face scale”): a novel coma scale for children less than two years of age. J Neurotrauma. 2000;17:729–737
  6. Hahn Y, McLone D. Risk factors in the outcome of children with minor head injury. Pediatr Neurosurg. 1993;19:135–142
  7. Greenes DS, Schutzman SA. Occult intracranial injury in infants. Ann Emerg Med. 1998;32:680–686
  8. Levin H, Aldrich E, Saydjari C, et al. Severe head injury in children: experience of the traumatic coma data bank. Neurosurgery. 1992;31:435–444
  9. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents: Chapter 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient. Pediatr Crit Care Med. 2003;4:S12–S18
  10. Jones PA, Andrews PJ, Midgley S, et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol. 1994;6:4–14
  11. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents: Chapter 18. Nutritional support. Pediatr Crit Care Med. 2003;4:S68–S71
  12. American College of Surgeons Subcommittee on Advanced Trauma Life Support. Advanced trauma life support instructor manual. Chicago (IL): American College of Surgeons; 1993;
  13. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents: chapter 12. Use of hyperventilation in the acute management of severe pediatric traumatic brain injury. Pediatr Crit Care Med. 2003;4:S45–S48
  14. Halley MK, Silva PD, Foley J, et al. Loss of consciousness: when to perform computed tomography?. Pediatr Crit Care Med. 2004;5:230–233
  15. Portela L, Brenol J, Walz R, et al. Serum S100B levels in patients with lupus erythematous: preliminary observation. Clin Diagn Lab Immunol. 2002;9:164–166
  16. Palchak MJ, Holmes JF, Vance CW, et al. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?. Pediatrics. 2004;113:e507–e513
  17. Schunk JE, Rodgerson JD, Woodward GA. The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care. 1996;12:160–165
  18. Dietrich AM, Bowman MJ, Ginn-Pease ME, et al. Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?. Ann Emerg Med. 1993;22:1535–1540
  19. Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years: are there predictors for complications?. Arch Pediatr Adolesc Med. 1999;153:15–20
  20. Simon B, Letourneau P, Vitorino E, et al. Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma. 2001;51:231–237
  21. Dacey RG, Alves WM, Rimel RW, et al. Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients. J Neurosurg. 1986;65:203–210
  22. Hahn YS, Chyung C, Barthel MJ, et al. Head injuries in children under 36 months of age: demography and outcome. Childs Nerv Syst. 1988;4:34–40
  23. Steele BD, Brennan PO. A prospective survey of patients with presumed accidental ear injury presenting to a paediatric accident and emergency department. Emerg Med J. 2002;19:226–228
  24. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents: Chapter 3. Prehospital airway management. Pediatr Crit Care Med. 2003;4:S9–S11
  25. Committee on Quality Improvement, American Academy of Pediatrics, and the Commission on Clinical Policies and Research, American Academy of Family Physicians. The management of minor closed head injury in children. Pediatrics. 1999;104:1407–1415
  26. Kamerling SN, Lutz N, Posner JC, et al. Mild traumatic brain injury in children: practice guidelines for emergency department and hospitalized patients. Pediatr Emerg Care. 2003;19:431–440
  27. Brenner D, Elliston C, Hall E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:289–296
  28. Benz MG, Benz MW. Reduction of cancer risk associated with pediatric computed tomography by the development of new technologies. Pediatrics. 2004;114:205–209
  29. Stein SC, Spettell C, Young G, et al. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery. 1999;32:25–31
  30. Deitch D, Kirshner HS. Subdural hematoma after normal CT. Neurology. 1989;39:985–987
  31. Lovell MR, Collins MW, Iverson GL, et al. Grade 1 or “Ding” concussions in high school athletes. Am J Sports Med. 2004;32:47–54
  32. Collins MW, Lovell MR, McKeag DB. Current issues in managing sports-related concussion. JAMA. 1999;282:2283–2285
  33. Asarnow RF, Satz P, Light R, et al. Behavior problems and adaptive functioning in children with mild and severe closed head injury. J Pediatr Psychol. 1991;16:543–555
  34. Beers SR. Cognitive effects of mild head injury in children and adolescents. Neuropsychol Rev. 1992;3:281–320
  35. Billmire M, Myers P. Serious head injury in infants: accident or abuse?. Pediatrics. 1985;75:340–342
  36. Bruce D, Zimmerman R. Shaken impact syndrome. Pediatr Ann. 1989;18:482–494
  37. O'Neill J, Meacham W, Griffin J. Patterns of injury in the battered child syndrome. J Trauma. 1973;13:332–339
  38. Jenny C, Hymel KP, Ritzen A, et al. Analysis of missed cases of abusive head trauma. JAMA. 1999;281:621–626
  39. Ingebrigtsen T, Romner B. Biochemical serum markers of traumatic brain injury. J Trauma. 2002;52:798–808
  40. Akhtar JI, Spear RM, Senac MO, et al. Detection of traumatic brain injury with magnetic resonance imaging and S-100B protein in children, despite normal computed tomography of the brain. Pediatr Crit Care Med. 2003;4:322–326
  41. Soares H, Bednar M, Mennti F, et al. S100 and NSE correlate with clinical outcomes in severe traumatic brain injury. J Neurotrauma. 2003;20:1080
  42. Ingebrigtsen T, Waterloo K, Jacobsen E, et al. Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements in magnetic resonance imaging and neurobehavioral outcome. Neurosurgery. 1999;45:468–476
  43. Romner B, Ingebrigtsen T, Kongstad P, et al. Traumatic brain damage: serum S-100 protein measurements related to neuroradiological findings. J Neurotrauma. 2000;17:641–647
  44. Townsend WJ, Guy MJ, Pani MA, et al. Head injury outcome prediction in the emergency department: a role for protein S-100B?. J Neurol Neurosurg Psychiatry. 2002;73:542–546
  45. Bandyopadhyay S. Serum neuron-specific enolase as predictor of short term outcome in children with closed traumatic brain injury. Acad Emerg Med. 2004;11:514–515
  46. Kochanek PM, Safar PJ. Therapeutic hypothermia for severe traumatic brain injury. JAMA. 2003;289:3007–3009
  47. McIntyre LA, Fergusson DA, Hebert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. JAMA. 2003;289:2992–2999

PII: S1522-8401(04)00091-6

doi: 10.1016/j.cpem.2004.12.005

Clinical Pediatric Emergency Medicine
Volume 6, Issue 1 , Pages 8-15 , March 2005