Abstract
Pediatric head injury affects 400,000 children each year. Most recent reviews in the pediatric literature regarding head injury care have focused on the need for a computed tomography (CT) scan. Over the past 10 years there has been an explosion in knowledge about secondary mechanisms after an injury—concerning much more than just cerebral edema. At the biochemical level, these injury mechanisms include excitotoxicity, programmed cell death, inflammation, oxidative/nitrosative stress, and cerebral microvascular control. Each of these mechanisms may be unfamiliar, so a brief overview is provided. The interactions are very complex, and to enhance understanding, a conceptual model is presented. Four interventions are reviewed for potential use in emergency departments and emergency medical service settings. Research needs related to the head-injured child in the emergency department and emergency medical service setting are highlighted.
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