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Head Trauma in Children

Head injury, either alone or in association with multiple other injuries, is extremely common. The initial assessment and management of children who have a head injury is an important topic for all pediatricians.

Epidemiology

Table 1 lists definitions of minor, moderate, and severe head injuries as determined by the initial neurologic presentation. The most common method to assess a child's neurologic status initially is to assign a score based on the Glasgow Coma Scale (GCS). The GCS is determined by eye opening and best verbal and motor responses (Tables 2 and 3). Mild-to-moderate head injuries are far more common than severe injuries in the pediatric population. More than 90% of children requiring admission to a hospital following head injury have a GCS score of 13 to 15; severe head injury (GCS 8) accounts for approximately 5% of admissions.

Motor vehicle accidents, bicycle accidents, falls, sporting accidents, assaults, and child abuse are the most common causes of pediatric head injury. Despite a significant reduction in the number of pediatric fatalities due to implementation of the 55 mile/hour speed limit, motor vehicle accidents still result in a large number of hospital admissions and deaths each year. Many of these accidents are associated with drug or alcohol abuse.

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