Management of accidental minor head injuries in children: a prospective outcomes study

Object. The authors conducted a study to determine clinical, patient/family satisfaction, and financial outcomes following application of a management scheme that involves evaluation of computerized tomography (CT) scans and emergency department observation, rather than overnight admission, for children who have sustained accidental minor closed head injuries (Glasgow Coma Scale Scores 13-15) and who have met predefined clinical and radiographic criteria. Methods. During 18 consecutive months, all children age 24 months and older who sustained accidental minor head injuries were managed prospectively according to a standard protocol. All children meeting prospectively established clinical criteria underwent immediate CT scanning and were observed in the emergency department. Those in whom there were no intracranial radiographically demonstrated abnormalities and who met established clinical criteria were discharged to home observation. Two hundred fifteen children met the criteria for the study. Falls (53%) and motor vehicle accidents (13%) constituted the most common mechanisms of injury. Of the patients for whom information was recorded, 40% experienced a loss of consciousness and 49% had amnesia. Repeated vomiting occurred in 45%. Skull fractures were rare. No child suffered a clinical complication or neurological deterioration. Two patients (0.9%) underwent reevaluation within 48 hours for persistent symptoms; no intracranial abnormality was demonstrated in either on repeated CT scanning and both recovered uneventfully. Follow-up phone surveys in a subgroup of patients indicated universal parent satisfaction. Compared with a control group that underwent both CT scanning and were admitted to the hospital, statistically significant cost savings were realized in the cohort. Conclusions. A management scheme that involves routine initial CT studies and a brief period of observation in the emergency department is safe and readily accepted by patients and families and can achieve significant cost savings.