Although minor head injury is a frequent reason for emergency department (ED) visits by children, clinically significant traumatic brain injury (TBI) is uncommon.
Clinical decision rules are available to aid the identification of mildly head-injured children not requiring a computed tomography (CT) scan.
A concussion is a trauma-induced transient disturbance of brain function.
The emergency physician should recommend full physical and cognitive rest and prompt medical follow-up of all children who have sustained a concussion.
The terms concussion, minor head injury, mild closed-head injury, and mild traumatic brain injury (mTBI) have been variably used in scientific literature.1 Minor head injury, the broadest of these terms, refers to craniocerebral trauma and extracranial injury. The term closed-head injury is applied to injuries that do not involve penetration of the skull and dural layer. Mild closed-head injury and mTBI are often used interchangeably, although technically only mTBI implies the presence of cerebral injury. It is associated with symptoms such as brief loss of consciousness (LOC), disorientation, or vomiting. Like minor head trauma, patients with mTBI usually have Glasgow Coma Scale (GCS) scores of 13 to 15 when measured approximately 30 minutes after the injury. In comparison, patients with moderate TBI generally have initial GCS scores between 9 and 12, whereas those with severe injury have GCS scores ≤8. Epidemiologically, minor head trauma is generally defined separately in children younger than 2 years of age for many reasons: clinical assessment is often more difficult as infants in this age group with intracranial injuries are frequently asymptomatic, skull fractures may occur as the result of minor trauma, and inflicted injury occurs more often.2 The definition of minor head trauma for children 2 years of age and older has often been based on the GCS—some experts limit this term to children with a GCS of 15, whereas others have included children with scores ≥13. The definitions used by professional societies and experts for minor head injury and mTBI are provided in Table 9-1. Concussion and mTBI have been used synonymously. mTBI is a broader term defined by GCS and has structural and functional components, whereas concussion is more likely to be a subclassification of mTBI with poor relationship to GCS, and is largely a functional brain injury. Further discussion on concussion can be found at the end of this chapter.
TABLE 9-1Definition(s) for Minor Head Injury and mTBI |Favorite Table|Download (.pdf) TABLE 9-1 Definition(s) for Minor Head Injury and mTBI
|Professional Group ||Term Used ||Criteria |
|American Congress of Rehabilitation Medicine Mild TBI Committee (1993) ||Mild TBI || |
Traumatically induced physiologic disruption manifested by at least one:
|American Academy of Pediatrics (1999) ||Minor closed-head injury || |
Normal mental status on initial examination