Blunt Pediatric Head Trauma Requiring Neurosurgical Intervention: How Subtle Can It Be?

Lance Brown, James A. Moynihan, T. Kent Denmark

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Recent literature on pediatric head injuries has suggested that important intracranial injuries might present to the ED without typical signs or symptoms. The objective of our study was to review our institutional experience with head-injured infants and young children to assess the subtlety of the ED presentation. We performed a retrospective medical record review of head-injured children ≤10 years of age who underwent neurosurgical procedures from January 1, 1985, through November 28, 2001. We identified 110 children who met our inclusion criteria. All of the children had at least 2 signs or symptoms indicative of head injury. No single sign or symptom was present in all cases. Altered mental status was identified 85% of the time and was the most common sign or symptom. Eighteen children presented with a Glasgow Coma Scale score of 15 or the absence of abnormal mental status documented, but all of these children had other indications for head computed tomographic scanning. Emergency physicians should feel confident that standard history and physical examination skills are adequate to identify head-injured children who require neurosurgical procedures.

Original languageEnglish
Pages (from-to)467-472
Number of pages6
JournalAmerican Journal of Emergency Medicine
Issue number6
StatePublished - Oct 2003


  • Computed tomographic scanning
  • Craniotomy
  • Glasgow Coma Scale
  • Nonaccidental trauma
  • Occult


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