Children with Normal CT After Blunt Head Injury Are at Low Risk for Neurological Complications

No neurosurgical interventions were required in children with blunt head injury who had GCS scores of 14 or 15 and normal head CT scans in the emergency department.

In a planned secondary analysis of a prospective observational cohort study from PECARN (the Pediatric Emergency Care Applied Research Network), investigators evaluated the frequency of neurological complications in children (age, <18 years) with blunt head trauma (isolated or multisystem trauma), initial Glasgow Coma Scale (GCS) scores of 14 or 15, and normal emergency department head computed tomography (CT) scans. CT scans were performed at the discretion of the treating provider. Patients discharged to home were followed up at 1 week by telephone survey (capture rate, 79%); morgue and medical records were reviewed for patients with incomplete surveys.

Of 13,543 patients (mean age, 8.9 years; 20% <2 years) who met inclusion criteria during the 2-year study period, 2485 (18%) were hospitalized. Among hospitalized patients, 137 (6%) underwent subsequent neuroimaging, and 16 (0.6%) had abnormal findings. Among discharged patients, 197 (2%) underwent subsequent neuroimaging, and 5 (0.05%) had abnormal findings. No patient in either group required neurosurgical intervention.

Comment

Children with blunt head injury who have normal GCS scores and head CT scans can be safely discharged home with postconcussive follow-up care instructions regarding signs of deterioration and outpatient follow-up before resuming physical activities, such as sports.

Reviewing Author

Katherine Bakes, MD

Disclosures

RoyaltiesEmergency Medicine Secrets (Elsevier)

Grant/Research SupportDepartment of Justice

Editorial BoardsEmergency Medicine Secrets (Elsevier); Rosen’s Emergency Medicine (Elsevier)

Katherine Bakes, MD

Disclosures

RoyaltiesEmergency Medicine Secrets (Elsevier)

Grant/Research SupportDepartment of Justice

Editorial BoardsEmergency Medicine Secrets (Elsevier); Rosen’s Emergency Medicine (Elsevier)

Citation(s):

Holmes JF et al. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Ann Emerg Med 2011 Oct; 58:315.