Head Injury in Children

Head trauma in children is common and overwhelmingly benign. Severe forms, defined by a Glasgow Coma Scale (GCS) < 9, are the leading cause of death in children aged more than one year. Severity is related to the intracranial injuries identified by computed tomography (CT)-scan. Management of severe traumatic brain injuries (TBI) based on standardized critical care strategy in paediatric trauma centers aims to prevent secondary brain injuries. Early resuscitation starts on the scene and first need to stabilize main functions. Optimal management of the multitude of children with mild blunt head trauma (GCS: 13-15) remains to define. It relies on prognosis evaluation that determines the need for CT-scan. Emergency physicians must balance the possibility of missing a clinically significant TBI, especially those needing acute neurosurgery and the risks of future malignancies associated with ionizing radiation. The predictive values for TBI of skull fracture, scalp hematoma, loss of consciousness, amnesia, seizure, vomiting, rapid kinetics as well as age less than 2 years are controversial. Clinical decision rules identify TBI with an excellent sensitivity but with a high rate of obtaining normal CT-scans. The short observation of children for whom the benignity of head trauma cannot be definitively assessed based on the initial clinical evaluation seems to be beneficial.