Pediatric Major Head Injury: Not a Minor Problem

Emerg Med Clin North Am. 2018 May;36(2):459-472. doi: 10.1016/j.emc.2017.12.012. Epub 2018 Feb 10.

Abstract

Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients.

Keywords: Abusive head trauma; Blunt head injury; Intracranial hemorrhage; Traumatic brain injury.

Publication types

  • Review

MeSH terms

  • Brain Injuries* / diagnosis
  • Brain Injuries* / physiopathology
  • Brain Injuries* / therapy
  • Brain Ischemia / prevention & control
  • Child
  • Child Abuse / diagnosis
  • Decompressive Craniectomy / methods
  • Humans
  • Hyperthermia, Induced / methods
  • Intracranial Hypertension / prevention & control
  • Pediatric Emergency Medicine / methods*
  • Resuscitation / methods