A Synopsis of The American Academy of Pediatrics’ Practice Parameter on the Management of Minor Closed Head Injury in Children: Figure 1.

Abstract

1. John B. Coombs, MD* 2. Robert L. Davis, MD, MPH† 1. 2. *Chair of the Subcommittee on Management of Minor Head Injury for the American Academy of Pediatrics/American Academy of Family Physicians. Department of Pediatrics and Family Medicine, University of Washington School of Medicine, Seattle, Wash. 3. 4. †Consultant to the Subcommittee on Management of Minor Head Injury for the American Academy of Pediatrics/American Academy of Family Physicians. Department of Pediatrics and Family Medicine, University of Washington School of Medicine, Seattle, Wash. This article provides a summary of the practice parameter on closed head injury. The reader is urged to refer to the original document for a more thorough presentation.(1) Your next appointment is a “work in” of a 3-year-old child who sustained an apparently isolated head injury 2 hours ago while playing on the slide at a local playground. The child has been in your practice since birth and, other than treatment for two ear infections, has been healthy and has had no apparent underlying diseases. The injury was observed by his mother, a particularly fastidious, caring person, who indicates that after a period of 30 to 60 seconds, during which the child appeared lethargic, quiet, and poorly responsive to her, he cried and appeared somewhat fearful, finally responding to her questions appropriately and asking for a drink of water. On the way to the office, he vomited in the car, but has remained attentive and alert. You are concerned about the brief loss of consciousness that is suggested by the history. Your examination reveals a lump on the scalp, no laceration, and no evidence of other apparent injury beyond the head. Results of a careful neurologic examination are unremarkable, including mental status for age and funduscopic examination. You reassure the mother and retire to the hallway to contemplate your next step. In the United States, head trauma in children is common and a frequent reason for visits to the doctor’s office. Over the past 2 decades, more than 300,000 children have visited the doctor annually for a recent head injury, and nearly one third of these visits have ended with the child being hospitalized.(2),(3) For a seemingly simple, straightforward problem, surveys reveal significant variations in care for minor, closed head injury, as suggested by findings …