Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries.

Teasdale, G. M.; Murray, Gordon D.; Anderson, E.; Mendelow, AD; MacMillan, RH; Jennett, Bryan; Brookes, M

doi:10.1136/bmj.300.6721.363

Cited by 218 publications

(121 citation statements)

References 29 publications

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“…This study found that .017% of cases with a GCS score of 15 required surgery. 10 We conclude from these data that:…”

Section: Risk Of Intracranial Injurymentioning

confidence: 85%

Technical Report: Minor Head Injury in Children

Homer¹,

Kleinman²

1999

Pediatrics

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ABSTRACT. Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidencebased recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/ cgi/content/full/104/6/e78; head trauma, imaging, literature review.ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow coma scale. Minor head trauma affecting a child is a common reason for medical consultation and evaluation. No consensus exists concerning the appropriate diagnostic assessment of such children. Previous surveys of physicians indicated significant variation in practice, and examination of hospitalization rates shows substantial regional variation for this condition. The American Academy of Pediatrics, in coordination with the American Academy of Family Physicians, launched an initiative to develop a clinical practice guideline to reduce variation and improve the quality of care of children with minor head trauma.This report provides the technical information on the literature concerning minor head t...

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“…This study found that .017% of cases with a GCS score of 15 required surgery. 10 We conclude from these data that:…”

Section: Risk Of Intracranial Injurymentioning

confidence: 85%

Technical Report: Minor Head Injury in Children

Homer¹,

Kleinman²

1999

Pediatrics

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“…26) The presence of fracture was only assessed in 59% of our patients, but had a strong influence on intracranial lesions, as previously reported. 5,11,25,31) However, which patients should undergo skull radiography, and timing are unclear. Although the presence of fracture increases the likelihood of intracranial lesion, the sensitivity of skull radiography is not high enough to be a useful screening test, 8,12) as confirming the absence of fracture does not rule out intracranial injury.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

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The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

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“…Skull radiographs have been used as part of the evaluation for children with head trauma, yet their value remains controversial. [11][12][13] Head computed tomography (CT) has become the diagnostic method of choice for identification of intracranial disorders in patients with head trauma. 14 However, CT is expensive, not always readily available, sometimes requires sedation of the patient, and always requires skilled interpretation.…”

mentioning

confidence: 99%

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

et al. 1997

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ABSTRACT. Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma.Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head computed tomography, and data forms including mechanism of injury, symptoms, and physical findings were completed for each child.Results. Intracranial injury occurred in 27 children (8%), whereas 50 (16%) had skull fractures. Of those with intracranial injury, 16 (59%) had normal mental status and no focal abnormalities, and 1 of those 16 required surgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma without other symptoms. Findings not significantly associated with intracranial injury were scalp contusion, laceration, hematoma, abrasion, headache, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consciousness for more than 5 minutes, altered mental status, and focal neurologic abnormality.Conclusions. Intracranial injury may occur with few or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study. Pediatrics 1997;99(5). URL: http://www.pediatrics.org/cgi/content/full/99/5/e11; brain injuries, head injuries, skull fractures, computed tomography, radiography.

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Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries.

Cited by 218 publications

References 29 publications

Technical Report: Minor Head Injury in Children

Technical Report: Minor Head Injury in Children

Indications for Computed Tomography in Patients With Mild Head Injury

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

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