Head injury

Question 1

What is the most comomn cause of mortality and morbidity in th UK in children over 1 year?

Answer 1

Head injury

Question 2

How quickly do most children recover from a head injury?

Answer 2

Within 2 weeks

Question 3

What are red flag symptoms in head injury indications for?

Answer 3

Significant trauma or raised ICP

Question 4

What age group of children should always go to hospital with a head injury?

Answer 4

Under 1 yera olds
(More likely to be NAI)

Question 5

Questions to ask in history of head injury

Answer 5

Mechanism- speed/height
When
LOC - For how long, Seizures/abnormal behaviour
Vomitting - EPISODES
Headache
Altered behaviour
Clinical course - improving, stable, deteriorate
Other injuries eg cervical spine
Anti-coagulants
Unattended child, possible NAI

Question 6

How many vomitting episodes is normal in a child after head injury

Answer 6

Up to two
(two in quick succession = one episode)

Question 7

Examples of high energy head injuries

Answer 7

High speed/rollover motor vehicle collision
Child hit/ejected from vehicle
fall > 1m height
Bicycles
Fall/trampled large animal
Golf club, cricket/baseball bat

Question 8

Paediatric GCS under one year eye opening

Answer 8

Spontaneously - 4
Tp shout - 3
To pain - 2
No response - 1

Question 9

Motor response in under 1 year scale GCS

Answer 9

Spontaneous - 6
Localises pain - 5
Flexion-withdrawal - 4
Felxion abnormal (decorticate rigidity) - 3
Extension - decerebrate rigidity) - 2
No response - 1

Question 10

0-23 months GCS verbal response

Answer 10

Smiles/coos appropritately - 5
Cries and is consolable - 4
Persistent inappropriate crying and/or screaming - 3
Grunts, agitated, restless - 2
No response - 1

Question 11

2-5 years GCS verbal response

Answer 11

Appropriate words/phrases - 5
Inappropriate words - 4
Persistent cris and screams - 3
Grunts - 2
No response - 1

Question 12

> 5 years verbal response GCS

Answer 12

Oriented - 5
Disoriented/confused - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response - 1

Question 13

Red flags in head injury GCS immediate vs 2 hours

Answer 13

Immediaet - GCS < 14 , children < 1 year GCS <15
21 hours after GCS < 15

Question 14

Red flags in head injruy paeds

Answer 14

GCS <14 immediate, < 15 if under 1 year
GCS < 15 2 hours after
Open or depressed skull fracture or tense fontanelle
Sign of basal skull fracture
Focal neurological deficit
Post-traumatic seizure, no epilepsy history
Sus NAI
LOC > 5 mins - witnessed
Abnormal rowsiness
>3 episodes discreet vomitting
Dangerous mechanism of injury
Amnesia > 5 mins
>5cm mark on head < 1 year

Question 15

What size laceration bruise or swelling is a red flag in a child under 1 year?

Answer 15

> 5cm

Question 16

What size laceration bruise or swelling is a red flag in a child under 1 year?

Answer 16

> 5cm

Question 17

Signs of basal skull fracture

Answer 17

Haemotympanum
Panda eyes
CSF from ears or nose
Battles sign

Question 18

Post head injury advice for parents

Answer 18

Dont leave alone for 24 hours
Allow to sleep - observe regular, check repsond touch, breathe and position normal
Observe for next 2-3 dyas and check they’re responding as usual
Rest + avoid stress
Check respond normally move arms and legs
Paracetemol and ibuprofen if pain
Cold facecloth 20 miins every 3-4 hours if swollen or bruised
Completely revoered before back to school
No contact sport for 3 weeks

Question 19

How long can a child go before doing ontact sport again agter a singificatn head injury?

Answer 19

3 weeks