[Head injuries in the pediatric emergency department: a 5-year experience at the Pediatric Clinic of Modena].
We re-evaluated the cases of 436 children with minor head injury admitted in the paediatric department of Modena University Hospital in the years 1991-1995 in order to revise diagnostic and therapeutic protocols. The external lesions, the presence of loss consciousness, vomiting, vegetative reactions, late complications, skull X ray, TC scan and EEG were considered. Signs and symptoms at admission have been faced with instrumental findings and eventual late complications to evaluate the prognostic significance. External lesions and vomiting did not correspond to TC scan and EEG positivity or significant sequelae. A more close connection to these parameters was found when an history of immediate loss of consciousness after trauma, or presence of vegetative reactions. Skull X ray appeared useless both to judge the seriousness of the lesion and to formulate a prognosis. EEG appeared a sensible tool to evaluate the gravity of the trauma and its late consequences. TC has confirmed to be the unique instrument able to solve any diagnostic or prognostic doubt. When symptoms suggest a bad prognosis, diagnostic procedures should be limited to TC and EEG. By our point of view, patients that at admission have a normal neurological examination at the Glasgow Coma Scale, no significant symptoms and signs, an history of a minor impact dynamic and no signs of child abuse, can be discharged from the emergency department; in this case parents should be instructed how to do an observation at home in order to evaluate eventual complications.
Sturloni
N
N
Dipartimento di Scienze Ginecologiche, Ostetriche e Pediatriche, Università degli Studi di Modena, Italia.
Laudizi
L
L
Venuta
A
A
Venturelli
C
C
Bettelli
F
F
Franceschini
L
L
D000367:Age Factors; D002648:Child; D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009460:Neurologic Examination; D011379:Prognosis; D014057:Tomography, X-Ray Computed