Controversies in the evaluation and management of minor blunt head trauma in children.
OBJECTIVE
We present data from recently conducted research regarding controversial aspects of the evaluation and management of children with minor blunt head trauma.


RESULTS
Clinicians frequently but at times indiscriminately perform computed tomography scans for children with minor blunt head trauma resulting in potentially harmful radiation exposure. Recent guidelines recognize the limited but increasing data available to make strong recommendations regarding appropriate neuroimaging decisions. Investigators have derived and validated clinical prediction models to accurately identify patients with substantial traumatic brain injury, though no clear definitive rule exists. Children younger than 2 years appear to have a higher risk of intracranial injury following minor head trauma. These patients can be difficult to assess, with the evidence suggesting the need for a more conservative approach to diagnostic imaging. We present current and accepted definitions of concussion along with risk factors and treatment for postconcussion syndrome. Current return-to-play guidelines suggest that athletes who have sustained concussion should not resume play until symptoms have resolved because of the possibility, though rare, of second impact syndrome.


CONCLUSIONS
Research in the management of children with minor head trauma is actively evolving. We present a review of recent developments that can influence current clinical practice.
Schnadower
David
D
Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University College of Physicians & Surgeons, 622 West 168th Street, New York, NY 10032, USA. ds2194@columbia.edu
Vazquez
Hector
H
Lee
June
J
Dayan
Peter
P
Roskind
Cindy Ganis
CG
D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016489:Head Injuries, Closed / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007223:Infant; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000009:adverse effects