Technical report: Minor head injury in children

Minor head trauma affecting children is a common reason for medical consult ation and evaluation. In order to provide evidence on which to base a clini cal practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children. Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, ch ildren, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Rel evant articles were identified, reviewed, and abstracted. Additional citati ons were identified by review of references and expert suggestions. Unpubli shed data were also identified through contact with authors highlighting ch ild-specific information. Abstracted data were summarized in evidence table s. The process was repeated in 1998, updating the review for articles publi shed between 1993 and 1997. Results. A total of 108 articles were abstracted from 1033 abstracts and ar ticles identified through the various search strategies. Variation in defin itions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inc onsistent across studies. Computed tomography scan is most sensitive and sp ecific for detection of intracranial abnormalities; sensitivity and specifi city of skull radiographs ranged from 21% to 100% and 53% to 97%, respectiv ely. No high quality studies tested alternative strategies for management o f such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function. Conclusions. The literature on mild head trauma does not provide a sufficie nt scientific basis for evidence-based recommendations about most of the ke y issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field.