Challenges in minor TBI and indications for head CT in pediatric TBI—an update
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Pediatric head trauma is one of the commonest presentations to emergency departments. Over 90% of such head injuries are considered mild, but still present risk acute clinical deterioration and longer term morbidity. Identifying which children are at risk of clinically important brain injuries remains challenging and much of the data on minor head injuries is based on the adult population.
Challenges in pediatrics
Children, however, are different, both anatomically and in terms of mechanism of injury, to adults and, even within the pediatric group, there are differences with age and stage of development.
CT scans have added to the repertoire of clinicians in the assessment of pediatric head injury population, but judicious use is required given radiation exposure, malignancy risk, and resource constraints. Guidelines and head injury rules have been developed, for adults and children, to support decision-making in the emergency department though whether their use is applicable to all population groups is debatable. Further challenges in mild pediatric head trauma also include appropriate recommendations for school attendance and physical activity after discharge.
Concern remains for second-impact syndrome and, in the longer term, for post-concussive syndrome and further research in both is still needed. Furthermore, the development of clinical decision rules raises further questions on the purpose of admitting children with minor head injuries and answering this question may aid the evolution of clinical decision guidelines.
The next generation of catheter with homogeneous flow patterns based on parametric designs may represent a step forward for the treatment of hydrocephalus, by possibly broadening their lifespan.
KeywordsPediatric head trauma Glasgow Coma Score (GCS) Traumatic brain injury (TBI)
- 3.Oakley E, May R, Hoeppner T, Sinn K, Furyk J, Craig S, Rosengarten P, Kochar A, Krieser D, Dalton S, Dalziel S, Neutze J, Cain T, Jachno K, Babl FE, Paediatric Research in Emergency Departments International C (2017) Computed tomography for head injuries in children: change in Australian usage rates over time. Emergency medicine Australasia : EMA 29:192–197CrossRefPubMedGoogle Scholar
- 5.Roberts RM, Bunting J, Pertini M (2017) Factors that predict discharge recommendations following paediatric mild traumatic brain injury. Brain Inj:1–7Google Scholar
- 6.Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Chauvin-Kimoff L, Pusic M, McConnell D, Nijssen-Jordan C, Silver N, Taylor B, Stiell IG, Pediatric Emergency Research Canada Head Injury Study G (2010) CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 182:341–348CrossRefPubMedGoogle Scholar
- 7.Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL, Pediatric Emergency Care Applied Research N (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374:1160–1170CrossRefPubMedGoogle Scholar
- 13.Mannix R, Meehan WP, Monuteaux MC, Bachur RG (2012) Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments. J Pediatr 160(136–139):e131Google Scholar
- 15.Thiessen ML, Woolridge DP (2006) Pediatric minor closed head injury. Pediatric clinics of North America 53: 1–26, vGoogle Scholar
- 18.Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K, Children’s head injury algorithm for the prediction of important clinical events study g (2006) Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91:885–891CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR, Paediatric Research in Emergency Departments International C (2017) Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. LancetGoogle Scholar
- 20.Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS (2014) Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Annals of emergency medicine 64: 145–152, 152 e141-145Google Scholar
- 21.Babl FE, Lyttle MD, Bressan S, Borland M, Phillips N, Kochar A, Dalziel SR, Dalton S, Cheek JA, Furyk J, Gilhotra Y, Neutze J, Ward B, Donath S, Jachno K, Crowe L, Williams A, Oakley E, network Pr (2014) A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatr 14: 148Google Scholar
- 22.Mower WR (2017) Paediatric head imaging decisions are not child's play. LancetGoogle Scholar
- 37.Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ, Zafonte R (2013) Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the guideline development Subcommittee of the American Academy of Neurology. Neurology 80:2250–2257CrossRefPubMedPubMedCentralGoogle Scholar