Diagnostic approach to children with minor traumatic brain injury

Abstract

To analyse the management of minor traumatic brain injury (MTBI) in paediatric hospitals in Germany. An electronic survey was sent to 72 children hospitals. All participating (45/72; 62.5%) hospitals had facilities to perform an electroencephalogram (EEG), 98% cranial ultrasonography, 94% MRI studies, and 87% a CT scan. The initial Glasgow Coma Scale, the clinical presentation/neurological deficits, the intensity of the trauma and external/visible injuries were most important for initial assessment. The main reason for in-patient monitoring was initial clinical neurologic presentation (44%). X-ray scans were used routinely in only 2.2%, cMRI scans in 6.7% and cCT scans in 13.3%; approximately one third employed ultrasonography. In 22.2% was an EEG part of the routine diagnostic work-up. Inpatient monitoring for 24-48h was done in 80%. Children with MTBI are often monitored clinically without resorting to potentially harmful and expensive diagnostic procedures (cCT scans).