Emergency Department Assessment and Management of Pediatric Acute Mild Traumatic Brain Injury and Concussion

Points & Pearls Excerpt

• 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.⁸
• 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.
• Children aged <2 years are at increased risk for nonaccidental trauma. When nonaccidental trauma is suspected (inappropriate delay in care, unexplained mechanism of injury, or an injury not appropriate for the developmental stage of the child), a head CT, skeletal survey, and laboratory studies should be obtained. In addition, social work and Child Protective Services must be involved.⁸⁵