Skip to Main Content

++

Key Points

++

  1. The predominant mechanism of head injury in children varies with age. The leading cause of severe head injury in infants is nonaccidental, or inflicted, trauma.

  2. The physiologic processes resulting from acute head injury are divided into primary brain injury and secondary brain injury.

  3. Children with extensive cerebral shear injury on admission often have protracted hospitalizations with permanent neurologic deficits and poor functional outcomes.

  4. Avoidance of systemic hypotension, hypercarbia, hypoxemia, hyperglycemia, intracranial hypertension, and seizure activity can significantly minimize secondary injury following moderate or severe traumatic brain injury, thereby substantially reducing morbidity/mortality and improving functional outcomes.

  5. Children with a post-resuscitation GCS of ≤8 should generally undergo continuous ICP monitoring as part of their management.

  6. The classic triad of findings in children with inflicted injury includes subdural hematomas, retinal hemorrhages, and evidence of skeletal injury.

++

Three out of four children hospitalized for trauma have sustained a head injury. While most pediatric head injuries are minor, requiring only brief hospital stays for observation, injuries to the central nervous system still represent the most common cause of mortality in pediatric trauma patients. Management of the child with severe head injury requires special consideration be given to fundamental differences in pediatric and adult neurophysiology. In addition, certain mechanisms of traumatic brain injury (TBI), such as the “shaken baby syndrome,” are unique to infants and young children and can be quite devastating to the developing brain. Similarly, recovery patterns and potential following brain injury differ significantly between children and adults, affecting long-term rehabilitation strategies in the pediatric population. This chapter characterizes the major types of pediatric head injury and their treatment, highlighting similarities and differences between pediatric and adult management strategies where appropriate.

+
Alberico  AM, Ward  JD, Choi  SC,  et al Outcome after severe head injury: relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 1987;67:648–656.
CrossRef  [PubMed: 3668633]
+
Berger  MS, Pitts  LH, Lovely  M,  et al Outcome from severe head injury in children and adolescents. J Neurosurg 1985;62:194–199.
CrossRef  [PubMed: 3968558]
+
Chesnut  RM, Marshall  SB, Piek  J,  et al Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl 1993;59:121.  [PubMed: 8310858]
+
Dias  MS, Borchers  J, Hernan  L,  et al Evaluation and management of pediatric head trauma. In: Fuhrman BP, Zimmerman JJ, eds. Pediatric Critical Care. 2nd ed. St. Louis, MO: Mosby; 1998:1221.
+
Duhaime  AC, Christian  CW, Rorke  LB,  et al Nonaccidental head injury in infants—the “shaken baby syndrome.” N Engl J Med 1998;338:1822–1829.
CrossRef  [PubMed: 9632450]
+
Ersahin  Y, Mutluer  S, Mirzai  H, Palali  I. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst 1996;12:323–331.
CrossRef  [PubMed: 8816297]
+
Griesdale  DEG, Tremblay  MH, McEwen  J,  et ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.