PREDICTING SEVERITY OF HEAD INJURY BASED ON REASONS FOR HOSPITAL ADMISSION

Abstract

Most children hospitalized for head injury are admitted for assessment of neurologic status and for monitoring the development of complications. This retrospective study of 155 head injury pts. (2 mos. to 16 yrs.) hospitalized during 14 mos. determines predictive values of common admission criteria following head injury for the severity of head injury based on skull radiographs and head CT scans. Twenty seven pts. had severe head injury: 13 compound/depressed skull fracture, 6 epidural hematoma, 4 brain contusion, 2 cerebral edema, 1 subdural hematoma, 1 brain ischemia; 128 had minor head injury: 46 concussion, 35 minor trauma, 27 linear skull fracture (LSF), and 20 basilar skull fracture. Positive predictive values for severe head injury were: deep scalp laceration/large scalp swelling (75%); loss of consciousness (LOC) ≥5 min. (50%); focal neurologic deficit (42%); seizures (28%); altered consciousness (28%); severe headache (21%); any LOC (21%); LSF (18%); vomiting ≥5 times (12%); scalp swelling/abrasion (10%); retrograde amnesia (5%); anterograde amnesia (4%). Negative predictive values for severe head injury ranged from 97% for LSF to 75% for anterograde amnesia and scalp swelling/abrasion. Thus, certain "admission criteria" in head injury pts. are predictive of the severity of head injury: the more obvious the presenting abnormality (deep laceration, protracted LOC, focal CNS deficit, seizures), the more likely a severe head injury is present, and that prolonged vomiting, scalp injury, and amnesia are poor predictors of severe head injury.