J Korean Soc Emerg Med.  1999 Sep;10(3):456-465.

Clinical Analysis of Mild Head Trauma in Children Admitted to Department of Emergency Medicine

• Lim YS
• Youm SL
• Shin JH
• Ryoo E
• Yang HJ
• Park CW
• Lee K

Abstract

BACKGROUND: Head injury is one of the most common causes of emergency department visits and hospital admission in the pediatric populations, and most injuries are mild. In mild head injury, grading of severity and decision of hospital admission are difficult in the emergency department. Recent studies have suggested that patients with a normal head CT scan and neurologic exam following head injury can be safely discharged from the emergency department. However, previous studies have relied on incomplete patient follow-up and been limited for the most part to adult population. So we performed this study to assess clinical course and the incidence of significant CNS sequelae in children with a normal head CT scan and no focal neurologic sign after mild head injuries during hospital admission and follow-up for 1 month.
METHODS
We reviewal the records of children(n=209) admitted to the department of emergency medicine with closed head injuries from Jan. 1, 1996 to Dec. 31, 1996, who's initial Glasgow Coma Scale was 13 to 15, and have no focal neurologic sign and a normal head CT scan. RESULT: 209 patients were studied with a mean age of 6.8(range 3 months to 15years), and 66.5% were male. The most common mechanisms of injury were pedestrian T.A(50.2%) and fall(11.5%). Patients had a mean Glasgow coma scale of 14.8 and mean Abbreviated Injury Score of 1.3. Patients had clinical symptoms of headache(49.3%), vomiting(44.5%), loss of consciousness(LOC)(29.6%), amnesia(10.0%), sleepiness(8.6%), irritability(8.6%), confusion(2.9%) and seizure(1.9%). The mean duration of admission was 4.3 days(range: 6 hours-20 days) and the mean duration of symptom was 36.4 hours. No child developed significant CNS sequelae during hospital admission. However, during hospital admission, aye children(all were preschooler) had psychologic complication ; one child developed post-traumatic stress disorder requiring psychologic treatment for 3 months. Three children developed enuresis and two children developed night terror. During 1 month fallow-up, one child developed a symptomatic hemorrhagic contusion 5 days after the head injury, not requiring neurosurgical treatment.
CONCLUSION
Among children with an initial Glasgow Coma Scale of 13 to 15, a normal head CT scan and no focal neurologic sign after mild head injuries, delayed intracranial sequelae are extremely uncommon. So these patient may be discharged home with parental supervision and education for dose observation.

MeSH Terms

Adult
Child*
Contusions
Craniocerebral Trauma*
Education
Emergencies*
Emergency Medicine*
Emergency Service, Hospital
Enuresis
Follow-Up Studies
Glasgow Coma Scale
Head Injuries, Closed
Head*
Humans
Incidence
Male
Neurologic Manifestations
Organization and Administration
Parents
Stress Disorders, Post-Traumatic
Tomography, X-Ray Computed