Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma

Abstract

Head injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aim of this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome.

Keywords

head trauma - intracranial lesion - child

• References

• 1 Segui-Gomez M, MacKenzie EJ. Measuring the public health impact of injuries. Epidemiol Rev 2003; 25 (01) 3-19
• 2 Sigmund GA, Tong KA, Nickerson JP, Wall CJ, Oyoyo U, Ashwal S. Multimodality comparison of neuroimaging in pediatric traumatic brain injury. Pediatr Neurol 2007; 36 (04) 217-226
• 3 National Institute for Health Clinical Excellence. Head Injury: triage, assessment, investigation and early management of head injury in infants, children and adults. NICE Clin Guidelines 2007
• 4 Kuppermann N, Holmes JF, Dayan PS. , et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374 (9696): 1160-1170
• 5 Jehlé E, Honnart D, Grasleguen C. , et al. Traumatisme crânien léger (score de Glasgow de 13 à 15): triage, évaluation, examens complémentaires et prise en charge précoce chez le nouveau-né, l'enfant et l'adulte. Ann Fr Médecine Urgence 2012; 2 (03) 199-214
• 6 Babl FE, Borland ML, Phillips N. , et al; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet 2017; 389 (10087): 2393-2402
• 7 Ide K, Uematsu S, Tetsuhara K, Yoshimura S, Kato T, Kobayashi T. External validation of the PECARN head trauma prediction rules in Japan. Acad Emerg Med 2017; 24 (03) 308-314
• 8 Da Dalt L, Parri N, Amigoni A. , et al; Italian Society of Pediatric Emergency Medicine (SIMEUP); Italian Society of Pediatrics (SIP). Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr 2018; 44 (01) 7
• 9 Lorton F, Poullaouec C, Legallais E. , et al. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. Scand J Trauma Resusc Emerg Med 2016; 24: 98
• 10 Schnellinger MG, Reid S, Louie J. Are serial brain imaging scans required for children who have suffered acute intracranial injury secondary to blunt head trauma?. Clin Pediatr (Phila) 2010; 49 (06) 569-573
• 11 Vavilala MS, Kernic MA, Wang J. , et al; Pediatric Guideline Adherence and Outcomes Study. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med 2014; 42 (10) 2258-2266
• 12 Washington CW, Grubb Jr RL. Are routine repeat imaging and intensive care unit admission necessary in mild traumatic brain injury?. J Neurosurg 2012; 116 (03) 549-557
• 13 Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 2006; 105 (5, Suppl) 365-369
• 14 Givner A, Gurney J, O'Connor D, Kassarjian A, Lamorte WW, Moulton S. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg 2002; 37 (03) 381-385
• 15 Greenberg JK, Stoev IT, Park TS. , et al. Management of children with mild traumatic brain injury and intracranial hemorrhage. J Trauma Acute Care Surg 2014; 76 (04) 1089-1095
• 16 Khan MB, Riaz M, Javed G. Conservative management of significant supratentorial epidural hematomas in pediatric patients. Childs Nerv Syst 2014; 30 (07) 1249-1253
• 17 Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst 2006; 22 (04) 363-367
• 18 Tabori U, Kornecki A, Sofer S. , et al. Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma. Crit Care Med 2000; 28 (03) 840-844