Minor Head Injury

24 March, 2011 by: colinparker

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A little bump on the head… could cause a lot of trouble for you and me. Minor Head Injury used to mean GCS 13-15, nowadays it means GCS 14-15. This is the vast majority of head injury cases, and therefore we need to be really comfortable with their assessment and management.

Plug in and join us as we discover the origins of the 4-hour myth, the creative definition of concussion, and the correct use of the vomitometer…


Outline of the MHI PEMcast

[CP] Welcome, disclaimer, intro

Definition: GCS =14-15

Epidemiology (common, with serious sequelae uncommon)

Severe head injury discussed previously on D is for disability PEMcast (part 2)

Problem is identifying the child at risk for intracranial injury without clinical signs at time of assessment (vs identifying low-risk children who do not need CT)

Strategies include observation or investigation (head CT) or combination.

Assessment of Child with Minor Head Injury

[CP] Initial ‘eyeball’ – appearance, vital signs, ABCD

[KR] History

Past Medical History / background
Mechanism
Cause of injury (fall vs collapse vs NAI)
Loss of Consciousness (duration) – difficult to estimate
Seizure
Vomiting (lower threshold in children)
Headache
Behaviour

[KB] Examination

General
CNS: AVPU, pupils, activity, cerebellar, motor, sensory
GCS vs PGCS (discussed in D for Disability PEMcast)
Head: skin /scalp, Signs of BOS#
Higher functions: mental slowness
[CP] (DLROW, serial 3’s, days of week backwards)

Management of Child with MHI

Analgesia
?anti-emetics (probably not)
Observation – how long?
4 hour myth origins
Rectal or IM Caffeine? (1954 paper: Pickles)

Imaging

[KR] SXR – who? (infants, NAI, FB)

[KB] CT scan

Risks (radiation, cognitive, GA risk)
Costs
Implications of abnormal scan:
CT visible lesion vs lesion requiring neurosurgical intervention
Do we need to detect non-surgical abnormalities?

Concussion

[CP] Definition?

What to expect
Sport and return to sport

[KR] Discharge advice – safety net
Verbal vs written

[ALL] Clinical bottom line, tips, personal experience

[CP] Summary, goodbye, see you next time, when we get seriously evidence-heavy with CT decision rules…

PICKLES W, McOSKER TC. Head injuries in children. Pediatr Clin North Am. 1954 Nov:787-99. PubMed PMID: 13204073.

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