Minor head injury in children - Current management practices of pediatricians, emergency physicians, and family physicians

Objective: To describe variation in the clinical management of minor head t rauma in children among primary care and emergency physicians. Design: A survey of pediatricians, family physicians, and emergency physici ans drawn from a random sample of members of the American Academy of Pediat rics, the American Academy of Family Physicians, and the appropriate Americ an Medical Association specialty listings, respectively. Physicians were gi ven clinical vignettes describing children presenting with normal physical examination results after minor head trauma. Different clinical scenarios ( brief loss of consciousness or seizures) were also presented. Information w as gathered on initial and subsequent management steps most commonly used b y the physician. Results: Surveys were returned by 765 (51%) of 1500 physicians. Of these, 3 03 (40%) were pediatricians, 269 (35%) family practitioners, and 193 (25%) emergency physicians. For minor head trauma without complications, observat ion at home was the most common initial physician management choice (n = 54 7, 72%). Observation in office or hospital was chosen by 81 physicians 11%. Head computed tomographic (CT) scan was chosen by 7 physicians (1%) and sk ull x-ray by 24 physicians (3%) as the first management option. Most physic ians (n = 445,80%) who initially chose observation at home would obtain a C T scan if the patient showed clinical deterioration. In the original scenar io, if the patient had also sustained a loss of consciousness, 383 physicia ns (58%) altered management. Of these, 120 (18%) chose CT, 13 (2%) chose sk ull x-ray, 1 (1%) chose magnetic resonance imaging, 141 (21%) chose inpatie nt observation, and 125 (19%) chose a combination of CT scanning and observ ation. With seizures, 595 (90%) altered management, with 176 physicians (27 %) choosing CT scan, 5 (1%) skull x-ray, 60 (9%) inpatient observation, and 299 (45%) a combination of radiological evaluation and observation. Conclusions: Most physicians surveyed chose clinic or home observation for initial management of minor pediatric head trauma. Clinical management was more varied when patients had sustained either loss of consciousness or sei zures. Further study of the appropriate management of minor head trauma in children is needed to guide physicians in their care.