Altered Mental Status in Children After Traumatic Brain Injury

Abstract

Pediatric head injuries are common and may present with varying degrees of altered mental status in children. The approach to evaluation, diagnosis, treatment, and prevention of further injury is important in achieving good health outcomes after a head injury. In this article, we review the pathophysiology, classifications, signs and symptoms, and management of traumatic brain injury. We also discuss the importance of preventing a secondary injury during recovery by educating families about head injury sequelae and return-to-play guidelines. [ Pediatr Ann. 2019;48(5):e192–e196.]

The Underreporting of Traumatic Brain Injuries in Pediatric Craniomaxillofacial Trauma –A 20 Year Retrospective Cohort Study

“…15 In addition, CMF trauma patients with concomitant moderate or severe TBIs more often have skull and upper-third fractures (Table 7), and less often middle-third fractures (Table 4), suggesting overlapping mechanisms of injury. Consequently, because of this high concomitant presentation, our analyses provide support for evaluating all pediatric CMF trauma patients for TBI to ensure appropriate management and prevention of secondary brain injury after the initial trauma, 22,23 especially as these patients have higher rates of mortality at 2 years (Table 3). This is especially the case for patients presenting with lower GCS scores or Injury Severity Scores, 23 male patients, blunt injury patterns, or skull and upper-third skull fractures, as demonstrated by findings from this study (Tables 3 and 4).…”

“…Because pediatric populations have demonstrated capacity for significant clinical improvements in TBI recovery as late as 12 months after injury, the importance of long-term monitoring cannot be overstated, 10,21 including prevention of secondary brain injury after initial trauma. 22,23 Given how critical long-term care is in TBI, the underreporting of TBI in CMF trauma is especially concerning. 24 Because of the paucity of data regarding TBI associated with CMF trauma in the pediatric population, the purpose of this study was to study the subpopulation of pediatric TBI among pediatric CMF trauma patients and characterize the incidence, treatment, and outcomes of pediatric patients who present with CMF trauma and concomitant TBI.…”

“…Because pediatric populations have demonstrated capacity for significant clinical improvements in TBI recovery as late as 12 months after injury, the importance of long-term monitoring cannot be overstated, 10,21 including prevention of secondary brain injury after initial trauma. 22,23 Given how critical long-term care is in TBI, the underreporting of TBI in CMF trauma is especially concerning. 24…”

Pediatric Head Traumas: A Different perspective

“…[1] Although most of childhood head injuries are minor, many children die or develop permanent disabilities each year from head trauma. [2][3][4] The most common causes of head injuries in children are motor vehicle accidents, falls, assaults, bicycle accidents and sport traumas. Most serious head injuries in infants younger than one year old are related to child abuse or abusive head traumas.…”

“…The child's neurological symptoms may include: loss of consciousness, headache, dizziness, nausea and vomiting, difficulty walking, slurred speech, amnesia, seizure and hemiparesis or hemiplegia. [1,2,4,8,9] MATERIALS AND METHODS Ethical approval was obtained for this retrospective study. The data of pediatric patients (0-18 years) who were admitted and treated for head trauma in our department between 2010 and 2019 were retrospectively reviewed.…”