Head injury

• Head injuries are common in children, accounting for up to 50% of head injuries presented to the emergency department.
• What are the signs & symptoms of head injury in children?

  Headache

  Confusion

  Reduced consciousness or drowsiness

  Vomiting

  Seizures

  Post-concussion syndrome

  • headache, dizziness, nausea
  • visual changes (double vision, blurring)
  • increased sensitivity to noise/light
  • brain fog or cognitive difficulties
  • emotional lability
  • infants may be irritable with a change in feeding or sleep
• What is a key thing to consider in head injuries in children?

  Non-accidental injury

  If suspected, should be escalated to a senior A&E doctor/paediatrician

  Child may require admission & detailed skeletal survey (esp if child is immobile or very young)
• What are the Inx of head injury in children?

  Full examination

  CT scan (if indicated)

  Monitoring for 4 hrs (if indicated)
• What indicates a CT head in head injury under 16s?

  CT head performed within 1 hour if more than 1 of the following RFs...

  • loss of consciousness lasting more than 5 mins
  • abnormal drowsiness
  • 3 or more episodes of vomiting
  • dangerous mechanism of injury
  • amnesia lasting more than 5 mins
  • any current bleeding or clotting disorder

  Pts with only 1 RF should be monitored for a minimum of 4 hours
• Paediatric GCS

  
• Paediatric GCS < 2 yrs

  
• What is the management of head injury in children?

  Depends on severity of head injury

  Minor head injuries -> rest, paracetamol, ice packs, safety net to look for signs of deterioration

  Severe head injuries -> neurosurgical input
• What are the possible complications of head injuries in children?

  Intracranial bleeds

  Seizures

  Loss of consciousness

  Coma

  Infections (if associated fractures are present)