CLOSED-HEAD INJURIES IN CHILDREN - IS HOSPITAL ADMISSION ALWAYS NECESSARY

The objective of this study was to identify a group of patients with m ild closed head injury, lack of other significant trauma, and normal h ead computerized tomograph (CT), who could be safely observed at home by a reliable caretaker. Data were from a retrospective chart review o f pediatric emergency department (PED) and hospital course of an urban university children's hospital. The pediatric trauma registry was use d to identify patients one to 17 years old seen in the PED with closed -head injury and normal head CT between June 1991 and August 1992. A t otal of 746 patients with head injury were seen in the PED, and 161 pa tients with closed-head injury were admitted during the study period. Sixty-two patients (mean age=8.5 +/- 5 years) met inclusion criteria w ith hospital admission, mild head injury, Glasgow Coma Scale greater t han or less than 13, and normal head CT. Of the patients 63% (34) were male and 37% (23) were female, with 74% (46) African-American and 26% (16)Caucasian. The most frequent mechanisms of injury were 27% (17) f all from height (mean height =6.7 +/- 4.6 feet) and 18% (11) passenger in a motor vehicle accident. Patients had a median Glasgow Coma Scale of 15 (mean 14.8) and median abbreviated injury score of 2 (mean =1.8 ). Thirty-seven percent of patients (23) had a history of loss of cons ciousness (range one to five minutes) and 6% (4) had generalized tonic -clonic seizure after the injury. Initial neurologic examination in th e PED was normal in 79% (49) patients. Head CT scans performed on pati ents showed no acute signs of injury. All patients had an uncomplicate d hospital course with mean duration of stay 1.3 +/- 0.6 days. Dischar ge neurologic examination was normal for 95% (60) patients; two remain ing patients had prior neurologic injury and short-term memory loss, r espectively. The negative predictive value of a normal head CT scan in patients with mild closed head injury and normal neurologic examinati on was 100% (95% confidence interval -94-100%). This retrospective cha rt review suggests that pediatric patients with mild closed-head injur y who have a nonfocal neurologic examination and a normal head CT are unlikely to develop neurologic deficits during their hospital course. These patients may be candidates for observation at home by a reliable caretaker, rather than in the hospital.