Electroencephalogram in children with minor traumatic brain injury

Background: Mild traumatic brain injury (MTBI) is one of the most frequent causes for hospitalisation in childhood. Because of different guidelines in the management the diagnostic approach varies substantially. Apart from neuroimaging studies (CT, MRI, sonography) an electroencephalogram (EEG) is often performed without any evidence-based data supporting its use. Methods: Retrospective analysis of 150 children with MTBI (age 0-16 years), who were admitted to the Children's Hospital of the University of Saarland from January 2006 to December 2007. Results: Mean age was 4.3 (SD 3.6) years: 55.3% were boys. The most common mechanisms of injury were: Minor fall <1 m of height (60%) and fall >1.5 m of height (10%). The most common symptoms were: one or more episodes of vomiting (60%), somnolence (26.7%) and headache (12.7%). On 118 patients an EEG was performed; 106 (89.8%) were normal, 11 (9.3%) pathological and 1 (0.9%) invalid because of artefacts. The pathological EEGs showed focal findings with localised slowing in nine cases, spike-wave complexes in one case and general slowing in one case. Of the 11 patients with pathological EEG, two had a CT scan, two a MRI and two had cranial sonography; all the neuro-imaging was normal. None of the children required neurosurgical intervention, had a negative outcome or showed persistent symptoms. Conclusion: The routine performance of an EEG after MTBI in children is not indicated because in most of the cases it is unrevealing, and may lead to unnecessary diagnostic procedures. Instead, children with MTBI should be closely monitored for possible clinical complications and neurological deterioration.