title: Pediatric head injury: a pain for the emergency physician?
abstract: The prompt diagnosis and initial management of pediatric traumatic brain injury poses many challenges to the emergency department (ED) physician. In this review, we aim to appraise the literature on specific management issues faced in the ED, specifically: indications for neuroimaging, choice of sedatives, applicability of hyperventilation, utility of hyperosmolar agents, prophylactic anti-epileptics, and effect of hypothermia in traumatic brain injury. A comprehensive literature search of PubMed and Embase was performed in each specific area of focus corresponding to the relevant questions. The majority of the head injured patients presenting to the ED are mild and can be observed. Clinical prediction rules assist the ED physician in deciding if neuroimaging is warranted. In cases of major head injury, prompt airway control and careful use of sedation are necessary to minimize the chance of hypoxia, while avoiding hyperventilation. Hyperosmolar agents should be started in these cases and normothermia maintained. The majority of the evidence is derived from adult studies, and most treatment modalities are still controversial. Recent multicenter trials have highlighted the need to establish common platforms for further collaboration.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Khai Pin
authors.initials: KP
authors.lastname: Lee
authors.affiliation: Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Gene Yong-Kwang
authors.initials: GY
authors.lastname: Ong
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
keywords: Brain injuries; Child; Craniocerebral trauma; Pediatrics