DIAGNOSTIC TESTING FOR ACUTE HEAD-INJURY IN CHILDREN - WHEN ARE HEAD COMPUTED-TOMOGRAPHY AND SKULL RADIOGRAPHS INDICATED

Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide in formation relevant to the choice of imaging modalities in children wit h acute head trauma. Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head com puted tomography, and data forms including mechanism of injury, sympto ms, and physical findings were completed for each child. Results. Intr acranial injury occurred in 27 children (8%), whereas 50 (16%) had sku ll fractures. Of those with intracranial injury, 16 (59%) had normal m ental status and no focal abnormalities, and 1 of those 16 required su rgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma withou t other symptoms. Findings not significantly associated with intracran ial injury were scalp contusion, laceration, hematoma, abrasion, heada che, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consc iousness for more than 5 minutes, altered mental status, and focal neu rologic abnormality. Conclusions. Intracranial injury may occur with f ew or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fo urfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study.