MANAGEMENT OF MODERATE HEAD-INJURY IN CHILDHOOD - DEGREE OF CONSENSUSAMONG CANADIAN PEDIATRIC EMERGENCY PHYSICIANS

The purpose of this study was to assess the degree of consensus among Canadian pediatric emergency physicians regarding the management of mo derate head injury in children. A questionnaire regarding the manageme nt of moderate head injury in a child was developed, and it concentrat ed on indications for admission and policies regarding skull radiograp h. The questionnaire was given to all pediatricians who are members of the Emergency Section of the Canadian Pediatric Society (n = 33) and who represent 15 Canadian pediatric emergency departments. The outcome was measured by the degree of consensus regarding management of child ren with moderate head injury. Twenty-three of 33 (70%) questionnaires , representing 14 of 15 (93%) emergency departments, were returned. On ly five of 23 (22%) questionnaires report routinely admitting otherwis e well children with short (three minutes or less) loss of consciousne ss; five (22%) routinely order a skull radiograph - three (13%) routin ely do both. Certain clinical indicators led to 70 to 80% agreement re garding admission: severe headache, seizures, depressed skull fracture , and persistent vomiting. Agreement of more than 70% regarding indica tions for ordering a skull radiograph was achieved only for clinical s uspicion of a depressed skull fracture. In conclusion, for the average child who is well after a loss of consciousness after a head injury l asting three minutes or less, the majority of respondents do not routi nely admit the child or order a routine skull radiograph. A reasonable degree of consensus (70-80%) regarding ordering of skull radiographs and admission is based on clinical criteria.