head injury
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Etiology
- falls (most common in children < 13 years of age)[1]
- assault, sports injury, motor vehicle accidents common among teens[2]
Pathology
- subdural hematoma, epidural hematoma
- subarachnoid hemorrhage
- cerebral contusion
- among patients with traumatic brain injury, 48% with more than one type of brain injury[1]
Radiology
- computed tomography (head CT, non-contrast)
- Glasgow coma scale < 13[10]; < 15[13]
- focal neurologic deficits
- anticoagulation
- routine repeat head computed tomography imaging in anticoagulated patients with a negative scan on admission is not cost-effective[11]
- severe headache[6] or persistent headache > 71 hours
- suspected skull fracture
- vomiting[6]
- dangerous mechanism of injury[6]
- ejection from a motor vehicle
- vehicle-pedestrian motor vehicle collision[6]
- falling from height > 3 feet
- anterograde amnesia[9]
- witnessed loss of consciousness[9]
- imaging modality of choice in acute setting[6]
- sensitivity
- 5% with mild head injury
- 27 with moderate head injury
- 65% with severe head injury[1]
- 3 clinical decision rules reduce unnecessary CT
- PECARN (Pediatric Emergency Care Applied Research Network)
- CATCH (Canadian Assessment of Tomography for Childhood Head Injury)
- CHALICE (Children's Head Injury Algorithm for the Prediction of Important Clinical Events)[4]
- CT angiography of the head & neck for suspected intracranial arterial injury
- CT venography for suspected intracranial venous injury[10]
- noncontrast maxillofacial CT, noncontrast temporal bone CT for suspected CSF leakage[10]
- magnetic resonance imaging (MRI)
Complications
- benign paroxysmal positional vertigo can result from head trauma[8]
- traumatic brain injury
- < 1% of older patients with initial negative head CT have delayed intracranial hemorrhage[5]
- a single head injury is linked an increased risk of all-cause mortality[12]
Management
- minor head injury in adults
- acetaminophen
- normal neurologic examination with 99.6% sensitivity for ruling out need for neurosurgery increased to 99.9% after 4-6 hours[2]*
- minor head injury in children & infants
- normal neurologic examination with 99.1% sensitivity for ruling out need for neurosurgery increased to 99.8% after 4-6 hours[3]*
- Pittsburgh Infant Brain Injury Score to assess abusive head trauma in infants[3]
- glucocorticoids worsen outcomes in severe head injury[6]
* distinguish from traumatic brain injury
More general terms
More specific terms
- craniofacial trauma
- facial trauma; maxillofacial trauma
- intracranial hemorrhage
- pneumocephalus
- severe head injury
- skull fracture (cranial fracture)
- traumatic brain injury (TBI)
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Quayle KS et al Epidemiology of Blunt Head Trauma in Children in U.S. Emergency Departments. N Engl J Med 2014; 371:1945-1947. November 13, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25390756 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMc1407902
- ↑ 2.0 2.1 2.2 The NNT: Risk Assessment: Minor Head Injury in Adults in the Emergency Department. http://www.thennt.com/risk/minor-head-injury-in-adults/
The NNT: Risk Assessment: Minor Head Injury in Infants and Children in the Emergency Department. http://www.thennt.com/risk/minor-head-injury-in-infants-and-children/ - ↑ 3.0 3.1 3.2 Berger RP, Fromkin J, Herman B et al. Validation of the Pittsburgh Infant brain Injury score for abusive head trauma. Pediatrics 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27338699 <Internet> http://pediatrics.aappublications.org/content/138/1/e20153756
- ↑ 4.0 4.1 Babl FE, Borland ML, Phillips N et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: A prospective cohort study. Lancet 2017 Apr 11; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28410792
Mower RW. Paediatric head imaging decisions are not child's play. Lancet 2017 Apr 11; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28410793 - ↑ 5.0 5.1 Chenoweth JA, Gaona SD, Faul M et al. Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma. JAMA Surg 2018 Feb 14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29450470 https://jamanetwork.com/journals/jamasurgery/article-abstract/2672215
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
- ↑ Rincon S, Gupta R, Ptak T. Imaging of head trauma. Handb Clin Neurol. 2016;135:447-477. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27432678
- ↑ 8.0 8.1 NEJM Knowledge+ Question of the Week. Feb 19, 2019 https://knowledgeplus.nejm.org/question-of-week/1346
- ↑ 9.0 9.1 9.2 Mori K, Abe T, Matsumoto J et al Indications for Computed Tomography in Older Adult Patients with Minor Head Injury in the Emergency Department. Acad Emerg Med. Aug 20, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32815620 https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.14113
- ↑ 10.0 10.1 10.2 10.3 American College of Radiology (ACR) Evaluation of Head Trauma Clinical Practice Guidelines (ACR, 2021). Medscape. May 28, 2021 https://reference.medscape.com/viewarticle/951966
Expert Panel on Neurological Imaging Shih RY, Burns J, Utukuri PS et al ACR Appropriateness Criteria <R> Head Trauma: 2021 Update. J Am Coll Radiol 2021 May 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33958108 https://www.jacr.org/article/S1546-1440(21)00025-9/fulltext - ↑ 11.0 11.1 Borst J, Godat LN, Berndtson AE et al. Repeat head computed tomography for anticoagulated patients with an initial negative scan is not cost-effective. Surgery 2021 Aug; 170:623. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33781587 https://www.surgjournal.com/article/S0039-6060(21)00117-3/fulltext
- ↑ 12.0 12.1 Anderson P Even One Head Injury Boosts All-Cause Mortality Risk. Medscape. Jan 27, 2023 https://www.medscape.com/viewarticle/987621
Elser H, Gottesman RF, Walter AE et al Head Injury and Long-term Mortality Risk in Community-Dwelling Adults. JAMA Neurol. Published online January 23, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36689218 https://jamanetwork.com/journals/jamaneurology/fullarticle/2800331 - ↑ 13.0 13.1 Silverberg ND, Iaccarino MA, Panenka WJ, et al; American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group Mild TBI Task Force. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020;101:382-393. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31654620