Paediatric head injury management

Question 1

paediatric head injury initial severity assessment levels, and how to class them

Answer 1

use GCS
* mild head injury, no risk factors - GCS 15
* mild head injury, with risk factors - GCS 14/15
* moderate head injury - GCS 9-13
* severe head injury - GCS 3-8

Question 2

what levels of paed head injury severity can be managed at GP

Answer 2

only mild head injury, no risk factors

Question 3

Paediatric head injury - risk factors
- presenting history (6)
- examination (4)
- b/g history (4)

Answer 3

presenting history
* severe headache
* persistent altered mental status
* severe mechanism
* post traumatic seizure
* loss of consciousness
* persistent vomiting

examination
* abnormal neurology
* palpable skull fracture
* signs of base of skull fracture
* non-frontal scalp haematoma, child <2years

b/g history
* known bleeding disorder
* VP shunt
* neurodevelopmental disability
* suspect child abuse

Question 4

paediatric head injury - severe mechanisms of head injury (5)

Answer 4

• MVA with patient ejection, rollover, another passenger dead
• pedestrian / cyclist vs motor vehicle
• fall > 1m (<2yo)
• fall > 1.5m (>2yo)
• head struck by high impact object

Question 5

Paediatric head injury - special conditions that increase risk

Answer 5

• age < 6 months
• bleeding diathesis
• immune thrombocytopaenia
• VP shunt
• neurodevelopmental disorders
• drug or alcohol intoxication

Question 6

paediatric head injury - signs of base of skull fracture

Answer 6

• haemotympanum
• CSF leak otorrhoea/rhinorrhoea
• periorbital bruising - raccoon eyes
• bruising over mastoid (battle sign)

Question 7

paediatric head injury - what is battle sign, what does it suggest

Answer 7

• bruising over mastoid, suggests possible BOSF