Pediatric Head Trauma: A Review and Update

Rose N. Gelineau-Morel; Timothy P. Zinkus; Jean-Baptiste Le Pichon

doi:10.1542/pir.2018-0257

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Rose N. Gelineau-Morel, MD*
Timothy P. Zinkus, MD^†
Jean-Baptiste Le Pichon, MD, PhD*

^*Division of Neurology and
^†Division of Radiology, Children’s Mercy Hospital, Kansas City, MO

AUTHOR DISCLOSURE
Drs Gelineau-Morel and Zinkus have disclosed no financial relationships relevant to this article. Dr Le Pichon has disclosed that he has served as a consultant for an AADC Deficiency Advisors Forum and as a medical legal expert and that he currently serves as the chair of the Subcommittee on Education for the American Academy of Pediatrics Section on Neurology Committee. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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

Practice Gaps

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.

Objectives

After completing this article, readers should be able to:

Differentiate a mild from a moderate or severe traumatic brain injury (TBI).
Acutely manage a child with a TBI, including deciding when further imaging is necessary.
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 …