PEDIATRIC HEAD-INJURIES - CAN CLINICAL FACTORS RELIABLY PREDICT AN ABNORMALITY ON COMPUTED-TOMOGRAPHY

Study objective: To assess clinical features that might reliably predi ct the need for computed tomography (CT) imaging in pediatric head tra uma. Design/setting/type of participant: Prospective cohort of 324 hea d CT scans performed on 322 consecutive trauma patients at an urban ch ildren's hospital. Results: Sixty-two percent of patients were male. T he mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was ob served on 35 scans (11%). Loss of consciousness, amnesia for the event , a Glasgow Coma Scale (GCS) of less than 15, and the presence of a ne urologic deficit were more common in children with intracranial injury (P<.05). Vomiting, seizures, and headache were not discriminating cli nical features. No single characteristic consistently identified the c hildren with an intracranial injury. Of the 195 children who were neur ologically intact (GCS, 15) at the time of presentation, 11 (5%) had e vidence of intracranial pathology on CT scan.Conclusion: This study de monstrates a poor correlation between the clinical symptoms of signifi cant traumatic brain injury and findings on CT.