[Management of isolated minor head trauma. A multicenter study].
OBJECTIVE
To detect intracranial injuries (ICI) earlier in children with minor head trauma through the use of a previously established decision tree.


METHODS
We performed a prospective multicenter study from September 2003 to January 2005. All patients aged between 3 months and 14 years old who visited the emergency department with minor head trauma (Glasgow Coma Scale score 13-15) were included. Six situations were established according to age (older or younger than 2 years) and low, intermediate or high risk for ICI. The management of each situation was suggested: observation at home, hospital observation or computed tomography (CT). The records of all patients were audited and categorized into: "properly classified, correct management", "properly classified but incorrect management", and "wrongly classified". All the patients were followed-up after discharge.


RESULTS
A total of 2148 patients were included. Low risk was assigned to 54.8 %, intermediate risk to 32.4 %, and high risk to 12.8 %. Observation at home or in hospital was assigned to 53.4 % and 24 % respectively. CT was performed in 22.6 %. ICI was detected in 1.6 % and 0.32 % required neurosurgery. There were 25 ICI in the high risk group, seven in the intermediate risk group, and none in the low risk group. No ICI were detected during follow-up. Most patients (90.1 %) were properly classified and the proposed management was carried out in 87.4 %.


CONCLUSIONS
When the recommendations of the management protocol were applied, early detection of ICI was achieved in all the situations in which these lesions occurred.
Bello Pedrosa
O
O
Departamento de Emergencia Pediátrica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. dptechp@chasque.apc.org
Prego Petit
J
J
Stewart Davies
J
J
Robuschi Lestouquet
F
F
D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000628:therapy; D003663:Decision Trees; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D011446:Prospective Studies