Posted by Andy Jagoda MD in: Brain Tease , trackback
Mild traumatic brain injury (mTBI) and concussion, a subtype of mTBI, commonly present to the emergency department and may present with symptoms identical to those associated with more severe TBI. The development and use of clinical decision rules, increased awareness of the risk of radiation associated with head computed tomography, and the potential for patient observation has allowed emergency clinicians to make well-informed decisions regarding the need for imaging for patients who present with mTBI.
Our recent issue Emergency Department Assessment and Management of Pediatric Acute Mild Traumatic Brain Injury and Concussion reviews the most recent literature on concussion and mTBI and provides recommendations for the evaluation, diagnosis, and treatment of mTBI and concussion in the acute setting.
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Here are a few key points:
- Currently, PECARN is the only validated clinical decision rule for pediatric patients aged <2 years with mild traumatic brain injury (mTBI). PECARN risk factors associated with increased risk for clinically important TBI in this age group include altered mental status, nonfrontal scalp hematoma, loss of consciousness for ≥5 seconds, severe mechanism of injury, palpable skull fracture, and acting abnormally per the parents.
- Patients with mTBI who present with an isolated episode of emesis, isolated headaches that are not severe or worsening, or isolated loss of consciousness are at very low risk for clinically important intracranial injury. In these cases, strong consideration should be given to observation in the ED as an alternative to head computed tomography (CT) scan.
- Children aged <1 year with larger-sized scalp hematomas in a nonfrontal location are at increased risk for TBI visible on CT, and neuroimaging should be considered.