Closed head injuries in childrenIs hospital admission always necessaryquest;

摘要

The objective of this study was to identify a group of patients with mild closed head injury, lack of other significant trauma, and normal head computerized tomograph (CT), who could be safely observed at home by a reliable caretaker. Data were from a retrospective chart review of pediatric emergency department (PED) and hospital course of an urban university children's hospital. The pediatric trauma registry was used to identify patients one to 17 years old seen in the PED with closed-head injury and normal head CT between June 1991 and August 1992. A total of 746 patients with head injury were seen in the PED, and 161 patients with closed-head injury were admitted during the study period. Sixty-two patients (mean age = 8.5 plusmn; 5 years) met inclusion criteria with hospital admission, mild head injury, Glasgow Coma Scale le; 13, and normal head CT. Of the patients 63percnt; (34) were male and 37percnt; (23) were female, with 74percnt; (46) African-American and 26percnt; (16) Caucasian. The most frequent mechanisms of injury were 27percnt; (17) fall from height (mean height = 6.7 + 4.6 feet) and 18percnt; (11) passenger in a motor vehicle accident. Patients had a median Glasgow Coma Scale of 15 (mean 14.8) and median abbreviated injury score of 2 (mean = 1.8). Thirty-seven percent of patients (23) had a history of loss of consciousness (range one to five minutes) and 6percnt; (4) had generalized tonic-clonic seizure after the injury. Initial neurologic examination in the PED was normal in 79percnt; (49) patients. Head CT scans performed on patients showed no acute signs of injury. All patients had an uncomplicated hospital course with mean duration of stay 1.3 + 0.6 days. Discharge neurologic examination was normal for 95percnt; (60) patients; two remaining patients had prior neurologic injury and short-term memory loss, respectively. The negative predictive value of a normal head CT sean in patients with mild closed head injury and normal neurologic examination was 100percnt; (95percnt; confidence interval = 94ndash;100percnt;).This retrospective chart review suggests that pediatric patients with mild closed-head injury who have a nonfocal neurologic examination and a normal head CT are unlikely to develop neurologic deficits during their hospital course. These patients may be candidates for observation at home by a reliable caretaker, rather than in the hospital.