Pediatric Head Injury

Shireen M. Atabaki

doi:10.1542/pir.28-6-215

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Shireen M. Atabaki, MD, MPH*

^*Attending Physician, Division of Emergency Medicine, Children's National Medical Center; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC

Objectives

After completing this article, readers should be able to:

Describe the clinical features and management of epidural hematoma.
Recognize that the syndrome of inappropriate antidiuretic hormone secretion is possible following head injury.
Know the association of cervical cord injury with head trauma.
Discuss the long-term cognitive/behavioral consequences of head trauma.

Epidemiology

Head injury is a leading cause of morbidity and mortality in childhood. More than 1.5 million head injuries occur annually in the United States, resulting in approximately 300,000 pediatric hospitalizations, with males twice as likely as females to sustain a head injury. Overall, up to 90% of injury-related deaths among children are associated with head trauma. Motor vehicle collisions are the most common cause of pediatric head injury, followed by falls. Football is the most common cause of sports-related head injury, with 75% of fatal head injuries occurring in high school students and 74% of football-related head injury fatalities associated with subdural hematomas. Head trauma injuries include scalp hematoma and laceration, skull fracture, intracranial hemorrhage, cerebral contusion, and diffuse axonal injury (DAI). Most children sustaining blunt head trauma have minor traumatic brain injury.

The American Association of Neurologic Surgeons defines traumatic brain injury (TBI) as a blow or jolt to the head or penetrating head injury that disrupts the normal function of the brain. Mild TBI may result in a brief change in mental state or consciousness; severe TBI may result in prolonged unconsciousness, coma, or death.

Anatomy

Any blow to the head can transfer energy from the skin, through the skull and meninges, to the brain. When evaluating head trauma, the clinician should remember the anatomic layers of the head that may be affected: the skin, galea aponeurotica, periosteum, cranial bone, epidural space, dura mater, subdural space, arachnoid mater, subarachnoid space, and brain (Fig. 1).

Figure 1.

Layers of the scalp …