Mandatory admission after isolated mild closed head injury in children: Is it necessary?☆

Presented at the 31st Annual Meeting of the American Pediatric Surgical Association, Orlando, Florida, May 25-29, 2000.
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Abstract

Background/Purpose: Children with closed head injuries diagnosed as concussion alone or concussion with brief loss of consciousness are admitted routinely for observation despite a normal central nervous system finding, negative computed tomography (CT) scan, and a Glasgow Coma Score (GCS) of 15. Recent studies have questioned the necessity of such an admission. The purpose of this study was to review a large pediatric database and study the length of stay as well as any required procedures or complications in these children. The hypothesis was that routine admission is unnecessary in this population. Methods: The National Pediatric Trauma Registry-Phase II was reviewed for the period from October 1988 to January 1996. Entry criteria included age less than 18 and an isolated closed head injury after blunt trauma with an admission GCS of 15. Variables studied included age, gender, mechanism of injury, length of stay, procedures, and outcome. Results: A total of 1,033 children met criteria for this study. The average age was 8.3 years. Males predominated at 61.9%. Falls, sports, and motor vehicle crashes were the most common mechanisms of injury. The average length of stay was 1.19 days, and 60 children were not admitted. A total of 583 children had no procedures performed, whereas 386 received a CT scan, and 148 had x-rays. None required neurosurgical intervention, and all were discharged alive. Conclusion: These findings indicate that routine admission may not be necessary for children with isolated mild closed head injuries with a negative CT scan and a normal neurologic finding and allows for a prospective randomized trial to confirm this. J Pediatr Surg 36:119-121. Copyright © 2001 by W.B. Saunders Company.

Section snippets

Materials and methods

The National Pediatric Trauma Registry-Phase II was reviewed for the period from October 1988 through January 1996. All children under the age of 18 who sustained an isolated closed head injury from blunt trauma and had an admission GCS of 15 were identified. The ICD-9 diagnosis codes of 850.0 and 850.1 were chosen as entry criteria because they represent concussion with no loss of consciousness or with brief loss of consciousness for less than 1 hour, respectively. The registry provided the

Results

After review of the 53,113 children in the National Pediatric Trauma Registry, 1,033 patients were identified as having isolated closed head injuries with an admission GCS of 15. Their average age was 8.34 ± 5.31 years. The majority of children were male—61.9% (2 had no gender recorded). All had an injury severity score of 4 representing their isolated closed head injury with less than a 1-hour loss of consciousness. All had sustained the closed head injury as a result of blunt trauma. Table 1

Discussion

Children who sustain mild closed head injuries represent a large number of evaluations in emergency departments every year. The question of disposition is most difficult when the child appears normal and has no evidence of traumatic injury on imaging studies. Guidelines are being developed for this group of patients. Every child should be evaluated carefully after a head injury, because a high degree of suspicion is necessary to find patients who might have complications. A GCS of 15 on

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☆

Address reprint request to Dennis W. Vane, MD, The University of Vermont College of Medicine, 111 Colchester Ave, Fletcher 4, MCHV Campus, Burlington, VT 05401.

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Copyright © 2001 W.B. Saunders Company. Published by Elsevier Inc. All rights reserved.