Evaluation and Management of Children Younger Than Two Years Old With Apparently Minor Head Trauma: Proposed Guidelines

• Sara A. Schutzman

  From the Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts;

• Patrick Barnes

  Pediatric Neuroradiology, Lucile Salter Packard Children's Hospital, Stanford University Medical School, Palo Alto, California; the

• Anne-Christine Duhaime

  Division of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the

• David Greenes

  From the Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts;

• Charles Homer

  Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts; the

• David Jaffe

  Division of Emergency Medicine, St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri; the

• Roger J. Lewis

  Department of Emergency Medicine, Harbor–UCLA Medical Center, UCLA School of Medicine, Torrance, California; the

• Thomas G. Luerssen

  Division of Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana; and the

• Jeff Schunk

  Division of Emergency Medicine, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.

抄録

In children <2 years old, minor head trauma (HT) is a common injury that can result in skull fracture and intracranial injury (ICI). These injuries can be difficult to detect in this age group; therefore, many authors recommend a low threshold for radiographic imaging. Currently, no clear guidelines exist regarding the evaluation and management of head-injured infants. We sought to develop guidelines for management based on data and expert opinion that would enable clinicians to identify children with complications of HT and reduce unnecessary imaging procedures. Evidence: References addressing pediatric HT were generated from a computerized database (Medline). The articles were reviewed and evidence tables were compiled. Expert Panel: The multidisciplinary panel was comprised of nine experts in pediatric HT. Consensus Process: A modified Delphi technique was used to develop the guidelines. Before the one meeting, panel members reviewed the evidence and formulated answers to specific clinical questions regarding HT in young children. At the meeting, guidelines were formulated based on data and expert consensus. A management strategy was developed that categorizes children into 4 subgroups, based on risk of ICI. Children in the high-risk group should undergo a computed tomography (CT) scan. Those in the intermediate risk group with symptoms of possible ICI should either undergo CT scan or observation. Those in the intermediate risk group with some risk for skull fracture or ICI should undergo CT and/or skull radiographs or observation. Those in the low-risk group require no radiographic imaging. We have developed a guideline for the evaluation of children <2 years old with minor HT. The effect of these guidelines on clinical outcomes and resource utilization should be evaluated.

収録刊行物

• Pediatrics

  Pediatrics 107 (5), 983-993, 2001-05-01

  American Academy of Pediatrics (AAP)

キーワード

• Pediatrics, Perinatology and Child Health

詳細情報

• CRID: 1364233269168705792
• NII論文ID: 30012915198
• DOI: 10.1542/peds.107.5.983
• ISSN: 10984275
• ISSN: 00314005
• Web Site: https://publications.aap.org/pediatrics/article-pdf/107/5/983/893529/983.pdf
• データソース種別:
  • Crossref
  • CiNii Articles