AMERICAN ACADEMY OF PEDIATRICS Technical Report: Minor Head Injury in Children

Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children. Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997. Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function. Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidencebased recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/ cgi/content/full/104/6/e78; head trauma, imaging, literature review. ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow coma scale. Minor head trauma affecting a child is a common reason for medical consultation and evaluation. No consensus exists concerning the appropriate diagnostic assessment of such children. Previous surveys of physicians indicated significant variation in practice, and examination of hospitalization rates shows substantial regional variation for this condition. The American Academy of Pediatrics, in coordination with the American Academy of Family Physicians, launched an initiative to develop a clinical practice guideline to reduce variation and improve the quality of care of children with minor head trauma. This report provides the technical information on the literature concerning minor head trauma in children that was used by the American Academy of Pediatrics/American Academy of Family Physicians subcommittee in formulating this guideline.