Mandatory admission after isolated mild closed head injury in children: Is it necessary?

• Published in: Journal of pediatric surgery Vol. 36; no. 1; pp. 119 - 121
• Main Authors: Adams, Julie, Frumiento, Carmine, Shatney-Leach, Lori, Vane, Dennis W.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.01.2001; Elsevier
• Subjects: Biological and medical sciences; Child; closed head injury; Concussion; Female; Head Injuries, Closed - diagnosis; Head Injuries, Closed - epidemiology; Head Injuries, Closed - etiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Injury Severity Score; Length of Stay - statistics & numerical data; Male; Medical sciences; minor head injury; Neurologic Examination; Patient Admission - standards; Registries; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; United States - epidemiology; United States; Concussion; minor head injury; closed head injury; Human; Nervous system diseases; Indication; Craniocerebral; Central nervous system disease; Diseases of the osteoarticular system; Skull disease; Hospitalization; Child; Trauma; Cerebral disorder
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2001.20026

Children with closed head injuries diagnosed as concussion alone or concussion with brief loss of consciousness are admitted routinely for observation despite a normal central nervous system finding, negative computed tomography (CT) scan, and a Glasgow Coma Score (GCS) of 15. Recent studies have questioned the necessity of such an admission. The purpose of this study was to review a large pediatric database and study the length of stay as well as any required procedures or complications in these children. The hypothesis was that routine admission is unnecessary in this population. The National Pediatric Trauma Registry-Phase II was reviewed for the period from October 1988 to January 1996. Entry criteria included age less than 18 and an isolated closed head injury after blunt trauma with an admission GCS of 15. Variables studied included age, gender, mechanism of injury, length of stay, procedures, and outcome. A total of 1,033 children met criteria for this study. The average age was 8.3 years. Males predominated at 61.9%. Falls, sports, and motor vehicle crashes were the most common mechanisms of injury. The average length of stay was 1.19 days, and 60 children were not admitted. A total of 583 children had no procedures performed, whereas 386 received a CT scan, and 148 had x-rays. None required neurosurgical intervention, and all were discharged alive. These findings indicate that routine admission may not be necessary for children with isolated mild closed head injuries with a negative CT scan and a normal neurologic finding and allows for a prospective randomized trial to confirm this.