Pediatric Head Trauma: A Review and Update

1. Rose N. Gelineau-Morel, MD* 2. Timothy P. Zinkus, MD† 3. Jean-Baptiste Le Pichon, MD, PhD* 1. *Division of Neurology and 2. †Division of Radiology, Children’s Mercy Hospital, Kansas City, MO * Abbreviations: AAP: : American Academy of Pediatrics AHT : : abusive head trauma CDC: : Centers for Disease Control and Prevention Child SCAT5: : Child Sport Concussion Assessment Tool CISG: : Concussion in Sport Group CT: : computed tomography DAI: : diffuse axonal injury FLAIR: : fluid-attenuated inversion recovery GCS: : Glasgow Coma Scale MRI: : magnetic resonance imaging mTBI: : mild traumatic brain injury TBI: : traumatic brain injury There is still a considerable amount of confusion when it comes to managing concussions. An excessive number of head computed tomographic scans are being obtained for concussions, resulting in unnecessary exposure to ionizing radiation. Clinicians should be aware of the most recent guidelines for the management of concussion, including the need for imaging, and should be able to differentiate mild from moderate and severe traumatic brain injury. After completing this article, readers should be able to: 1. Differentiate a mild from a moderate or severe traumatic brain injury (TBI). 2. Acutely manage a child with a TBI, including deciding when further imaging is necessary. 3. Manage a child with a postconcussion syndrome and identify when referral to a specialist is necessary. Traumatic brain injury (TBI) is the leading cause of death or severe disability in children older than 1 year. (1)(2) In a report to Congress published by the Centers for Disease Control and Prevention (CDC) in 2018, (3) the CDC reported the public health burden of TBIs. They noted that 640,000 emergency department visits and 18,000 hospital stays were directly related to TBI. The etiology of TBI varies among age groups. In the 0- to 4-year-old age group, the most common cause of TBI is falls. On the other hand, in the 15- to 24-year-old age group the distribution of injuries caused by …