title: Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.
abstract: There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 ± 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission.
authors.affiliation: Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: tplacke@lumc.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Plackett
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: sasturias@hotmail.com.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Asturias
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: matthewtadlockmd@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tadlock
authors.affiliation: Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: fwright@gmail.com.
authors.forename: Franklin
authors.initials: F
authors.lastname: Wright
authors.affiliation: Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: hton@lumc.edu.
authors.forename: Hieu
authors.initials: H
authors.lastname: Ton-That
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: demetria@usc.edu.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.affiliation: Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: tesposi@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Esposito
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: kenji.inaba@med.usc.edu.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging*; D006760:Hospitalization; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: Blunt head trauma; Closed head injury; Concussion; Pediatrics; Resource utilization; Traumatic brain injury