Pediatric minor closed head injury

Many studies have found conflicting evidence over the use of clinical indicators to predict ICI in pediatric MHI. Although altered mental status, LOC, and abnormal neurologic examination findings have all been found to be more prevalent among head-injured children, studies have observed inconsistent results over their specificity and predictive value. Children older than 2 years have been evaluated, managed, and studied differently than those younger than 2 years. Evidence strongly supports a lower threshold for performing a CT scan in younger children because they have a higher risk of significant brain injury after blunt head trauma. Many authors state that children with MHI who have normal CT scan results and normal mental status and neurologic examination findings may be discharged from the ED with a reliable caregiver and detailed head injury instructions. Further research involving multicenter trials with prospective enrollment will help to validate the decision making and previous recommendations on neuroimaging, hospitalization, observation, and discharge. Currently, the Pediatric Emergency Care Applied Research Network is conducting a multicenter study to address these questions. This study is currently in progress and has enrolled 16,000 children, with plans to enroll over 25,000 children. One of the goals is to create a neuroimaging decision rule on children with minor to moderate head trauma. Most children with MHI make a full recovery; however, a subset of children with preinjury morbidity may develop neuropsychologic sequelae. The management of sports-related head injuries demands identifying potential neurosurgical emergencies and preventing catastrophic outcomes related to acute brain swelling and repetitive concussions.