In Hungary, minor head injuries in children are treated by representatives of several professions according to local practice. Skull X-rays were often routinely performed, in contrast to international practice. To examine the previous and the current institutional minor head injury care protocol introduced in 2020. A retrospective, observational cohort study was conducted between 2018 and 2022 at the Heim Pál National Institute of Pediatrics. Before 2020, all children with head injuries were treated at the pediatric trauma outpatient clinic, and a skull X-ray was routinely performed. The protocol introduced in 2020 no longer required this for minor head injuries. Patients were divided into two groups: group A for those treated in 2018-2019 and group B for those treated in 2021-2022. Inclusion criteria were age 0-18 years, isolated, mild head injury. The number of X-ray examinations performed, outpatients or patients admitted to the ward were registered. The chi-square test was used for statistical analysis. 17.92% (n = 1886) of children in group A were admitted to the ward, while 34.11% (n = 2353) in group B were admitted (p<0.0001). 10520 patients in group A were treated for mild head injury, while 6898 patients in group B were treated. The number of X-rays performed in connection with all head injuries decreased in group B (1644/6898, 23.83%) compared to group A (9324/10520, 88.63%) (p<0.0001). The new protocol emphasizes observation and physical examination and does not recommend routine skull X-rays. Most patients with mild head injuries are now treated in the Emergency Department, while those with more severe symptoms or co-injuries are treated in the Traumatology Department. After the introduction of the new protocol, more patients were admitted, but for shorter periods of observation than before (6-24 hours instead of 48). Orv Hetil. 2026; 167(23): 916-922.

External validation and extended application of four clinical decision rules in minor head injuries.

Preinjury use of antithrombotic medication (PAM) may increase bleeding risk and adverse outcomes in older trauma patients. PAM is not routinely recorded in the Dutch trauma registry, leaving its impact on outcomes unclear. This study describes PAM among older trauma patients and assesses its association with injury patterns and patient outcomes, thereby informing whether routine documentation in trauma registries would be useful. Data from trauma patients aged ≥ 65 years admitted to hospitals within the West-Netherlands trauma region in June-September 2024 were obtained from the regional trauma registry. PAM was additionally documented during this period. Poor outcome was defined as in-hospital mortality and Glasgow Outcome Scale (GOS) score ≤ 3 at hospital discharge. Associations between PAM and outcomes were analyzed using multivariable logistic regression. Of 1,112 patients, 50% used antithrombotic medication, most commonly platelet aggregation inhibitors (47%) or direct oral anticoagulants (37%). Users were older, more often male, had more comorbidities, and more frequently sustained low-energy falls and minor head injuries. PAM was not associated with higher ISS (median 9 in both groups, p = 0.80), more intracranial hemorrhages (74% vs. 71%, p = 0.85), increased mortality (adjusted odds ratio [OR], 0.79; 95% Confidence Interval [CI], 0.41–1.53), or poor GOS at discharge (OR, 1.06; 95% CI, 0.79–1.43). PAM is common among older trauma patients. In this exploratory study, PAM did not seem to be associated with more severe injuries or poorer short-term outcomes. To evaluate the in-depth and long-term effects structured documentation of PAM in trauma registries is advocated.

Central diabetes insipidus (CDI) is an uncommon endocrine consequence of head injury in children and is typically associated with moderate to severe trauma. Development of CDI after trivial head injury, particularly in the presence of normal neuroimaging, is rare and may be easily overlooked. We report a 4-year-old child who presented with polyuria and polydipsia following a minor head injury, with laboratory findings consistent with central diabetes insipidus and normal magnetic resonance imaging of the brain. Prompt initiation of desmopressin resulted in rapid clinical improvement. This case emphasizes the need for clinical vigilance for CDI in children presenting with unexplained polyuria even after apparently insignificant head trauma.

Objectives:To examine: (1) differences in low-value care (LVC) for common emergency conditions by race and ethnicity in US children’s hospitals, and (2) the association between hospital characteristics, including LVC rate, and the magnitude of within-hospital LVC differences by race and ethnicity. We hypothesized smaller LVC differences in hospitals with lower overall LVC rates.Methods:We performed a cross-sectional study of children <18 years discharged from the emergency department with asthma, bronchiolitis, headache, or minor head injury in the Pediatric Health Information System (PHIS) from 1/2021–6/2023. Exposures were patient race and ethnicity (non-Hispanic Black, “Black;” non-Hispanic White, “White;” Hispanic) and de-identified PHIS hospital. Outcomes were LVC by race and ethnicity within and across hospitals. We used multivariable logistic regression, reporting adjusted odds ratios (aOR) and 95% confidence intervals (CI), to estimate hospital-level and condition-specific LVC differences, and linear regression to examine the association between LVC differences and LVC rates.Results:Among 314,138 eligible encounters, overall LVC rates were: asthma 18%, bronchiolitis 32%, headache 24%, and minor head injury 26%. White compared to Black and Hispanic patients had higher odds of LVC across multiple conditions in pooled and within-hospital analyses. The largest pooled differences were for White vs. Black: asthma aOR (95% CI) = 1.51 (1.18, 1.95) and headache 1.57 (1.43, 1.72). Hospital LVC rate was not associated with magnitude of within-hospital LVC difference for any condition.Conclusions:Lower hospital LVC rates were not associated with reduced LVC differences. Intentional focus on LVC differences is important when designing LVC reduction efforts.

This Special Communication summarizes how knowledge and clinical practice have evolved over the 40 years since the Journal of Head Trauma Rehabilitation 's topical issue (volume 1, issue 2) on "Minor Head Injury." We review important insights from this 1986 issue and highlight how research since has refined our understanding of concussion/traumatic brain injury pathophysiology, recovery, and long-term effects. We also discuss shifts in terminology and outline how assessment and rehabilitation approaches have developed over time. Finally, we call attention to areas of ongoing uncertainty and innovations that could help resolve them.

BackgroundThe Scandinavian Neurotrauma Committees (SNC) guideline is a validated and well established decision tool for pediatric minor to moderate head trauma in Sweden, categorizing patients into low, moderate and high risk for intracranial injury. It recommends observation over imaging with computer tomography in low and moderate risk stratified patients. However the effect on guideline implementation on emergency department length of stay and imaging rates with computer tomography is unknown.ObjectiveInvestigate the effects of the implementation of the SNC guidelines for pediatric minor head injury on utilization of computer tomography, emergency department length of stay and inhospital admission.MethodsA retrospective observation study between January 2011 and December 2022 in a health care system in south east Sweden where SNCs guideline was implemented at the beginning of 2017. Computer tomography imaging rates, emergency department length of stay and hospital admission was compared for pediatric visits with a chief complaint of head injury made before the implementation of the SNCs guidelines in January 2017 was compared with visits made after the implementation using segmented time series analysis.ResultsA total of 16,244 visits pre-implementation were compared with 16,164 post-implementation. Death, neurosurgical intervention and intracranial hemorrhage was rare (< 0.1% for each outcome) and did not differ between the pre-implementation and post-implementation group. Computer tomography rates were 3.3% before and 2.7% after implementation.The time-series analysis showed that the majority of the reduction happened pre-implementation (14% yearly decrease) compared to post-implementation (1.6% yearly decrease). Emergency department length of stay did not differ at 89 (interquartile range 50–150) vs 91 (interquartile range 45–159) (p = 0.11) minutes respectively. Hospital admissions showed a continual decrease during the whole study period with little effect of the guideline implementation (13% vs 12% yearly decrease, p = 0.6).ConclusionThere were lower rates of computer tomography in pediatric patients with minor to moderate head trauma after the implementation of the SNCs guidelines but the majority of the reduction in imaging happened before the guideline implementation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13049-026-01554-z.

ObjectiveThe aim of this study was to assess the variation in the use of head computed tomography (CT) scan in patients attending EDs with ground-level fall-related minor head injury. Secondary objectives were: i) to measure the prescription rate of appropriate head CT scan, ii) to identify patients’ and EDs characteristics associated with head CT scan prescription iii) to explore potential correlation between head CT scan use and traumatic intracranial hemorrhage (ICH) yield rate in this population.Materials and methodsThis research was a planned sub-analysis of a cross-sectional prospective multicentric study performed in 63 EDs in France (EPI-TC study). Patients sustaining ground-level fall-related with minor head injury were included in this sub-analysis. The main outcome was head CT scan performed during ED stay. Variations in the use of head CT scan were described depending on each ED and French region. Multiple fixed effects mixed logistic regression model was performed to identify factors associated with head CT scan.ResultsA total of 631 patients admitted for head injury after ground-level fall were included. Median age was 79 [63–88] years. A head CT scan was performed in 409 patients (64.8%, CI95% 61.0–68.5); 19.6% (CI95% 15.8–23.7) of them were appropriated; and 29 (7.1%, CI95% 4.8–10.0) showed a traumatic ICH. At regional level, head CT scan prescription rate ranged from 45.5% (CI95%: 24.4–67.8) to 84.6% (CI95% 54.5–98.1). Head CT scan use was not correlated with the yield rate of traumatic ICH. In multivariable analysis, preinjury antiplatelets (OR 29.2, CI95%: 12.2–69.9), anticoagulants (OR 69.9, CI95%: 20.0–243.9), syncope (OR 6.9, CI95%: 2.0–24.2), post-trauma amnesia (3.2, CI95%: 1.0–10.5) and post-trauma loss of consciousness (OR 5.6, CI95%: 2.0–15.9) were associated with head CT scan use.ConclusionsHead CT scan use in patient presenting to EDs with head injuries after ground-level falls is highly variable. High rate of head CT scan use is not correlated with high traumatic intracranial hemorrhage yield rate. The use of a clinical decision rule dedicated to this population would be suitable for harmonizing our practices.

The aim of this study was to assess the variation in the use of head computed tomography (CT) scan in patients attending EDs with ground-level fall-related minor head injury. Secondary objectives were: i) to measure the prescription rate of appropriate head CT scan, ii) to identify patients' and EDs characteristics associated with head CT scan prescription iii) to explore potential correlation between head CT scan use and traumatic intracranial hemorrhage (ICH) yield rate in this population. This research was a planned sub-analysis of a cross-sectional prospective multicentric study performed in 63 EDs in France (EPI-TC study). Patients sustaining ground-level fall-related with minor head injury were included in this sub-analysis. The main outcome was head CT scan performed during ED stay. Variations in the use of head CT scan were described depending on each ED and French region. Multiple fixed effects mixed logistic regression model was performed to identify factors associated with head CT scan. A total of 631 patients admitted for head injury after ground-level fall were included. Median age was 79 [63-88] years. A head CT scan was performed in 409 patients (64.8%, CI95% 61.0-68.5); 19.6% (CI95% 15.8-23.7) of them were appropriated; and 29 (7.1%, CI95% 4.8-10.0) showed a traumatic ICH. At regional level, head CT scan prescription rate ranged from 45.5% (CI95%: 24.4-67.8) to 84.6% (CI95% 54.5-98.1). Head CT scan use was not correlated with the yield rate of traumatic ICH. In multivariable analysis, preinjury antiplatelets (OR 29.2, CI95%: 12.2-69.9), anticoagulants (OR 69.9, CI95%: 20.0-243.9), syncope (OR 6.9, CI95%: 2.0-24.2), post-trauma amnesia (3.2, CI95%: 1.0-10.5) and post-trauma loss of consciousness (OR 5.6, CI95%: 2.0-15.9) were associated with head CT scan use. Head CT scan use in patient presenting to EDs with head injuries after ground-level falls is highly variable. High rate of head CT scan use is not correlated with high traumatic intracranial hemorrhage yield rate. The use of a clinical decision rule dedicated to this population would be suitable for harmonizing our practices.

Psychogenic non-epileptic seizures (PNES) are often associated with a history of mild traumatic brain injury, which may require differentiation with posttraumatic epilepsy, but usually there is a sufficiently long interval between an episode of trauma and their manifestations. Herein we report a case of a young female judo wrestler who experienced PNES immediately after minor head injury sustained during sport contest. It can be speculated that pathophysiological background of PNES in athletes may differ from general population and that disease in such cases may be related to stress of competition and fear to lose it. Early application of the video-electroencephalographic monitoring allows for timely diagnosis and initiation of appropriate treatment of PNES. J. Med. Invest. 73 : 265-269, February, 2026.

Posterior fossa arachnoid cysts are usually congenital and asymptomatic. Rapid enlargement after minor trauma is rare. Here, we report a case of a 1-year-old boy who developed a giant posterior fossa arachnoid cyst with obstructive hydrocephalus 1 month after a minor head injury, despite an initially normal CT scan. Follow-up CTs showed a giant arachnoid cyst in the right posterior fossa causing obstructive hydrocephalus and evidence of transtentorial herniation. He underwent surgery, and follow-up imaging confirmed cyst decompression, resolution of hydrocephalus, and full neurological recovery. To our knowledge, no previous reports have described a case in which initial neuroimaging was normal after trauma, but a giant arachnoid cyst subsequently formed within a short period, necessitating urgent surgery.

BackgroundHead-injured children are commonly transported to the Emergency Department (ED) by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Hospital clinicians use clinical decision tools to support their assessment of head-injured children; however, this is generally to determine whether a computed tomography (CT) scan is indicated. Currently, there is no pre-hospital clinical decision tool designed to support paramedics when assessing and managing head-injured children at scene. The aim of this study was to determine consensus amongst experts and stakeholders to inform the development of a new tool to support paramedics in safely assessing and managing children with minor head injury.MethodsA consultation process using a modified online Delphi technique comprising two rounds and a consensus meeting was completed between September 2023 and January 2024. A 5-point Likert scale was used to assess consensus, set a-priori at 67%. Free text survey responses arising from the Delphi were studied and concepts were developed. Data were analysed anonymously, and feedback was given after each round.ResultsAn expert stakeholder group comprising 36 participants took part in Round One, and 34 participants in Round Two of the online Delphi. The participants included parents/grandparents/caregivers, paramedics, primary care clinicians, ED doctors, ED nurses and Paediatricians. Consensus was reached in 36 statements following Rounds One and Two. The remaining eight statements were discussed at a consensus meeting, which was attended by 12 stakeholders. Seven of the eight statements reached agreement.ConclusionThis Delphi study has established consensus amongst a group of experts and stakeholders on the content and format of a pre-hospital paediatric head injury clinical decision tool, designed for use by paramedics: PATCH (Pre-hospital Assessment Tool for Children with Head injury). Future research should include an evaluation of the acceptability and usability of PATCH by paramedics.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12873-025-01362-1.

Unanticipated Consequences: Hypopituitarism After Minor Head Injury

532 External Validation and Extended Application of Four Clinical Decision Rules in Minor Head Injuries

239 Minor Head Injury in the Older Adult: Do All Patients Greater Than 65 Years Old Require Head Computed Tomography?

ABSTRACTObjectiveThe study aimed to evaluate the prevalence and impact of low‐value diagnostic tests at a regional, major‐referral, mixed Emergency Department (ED).MethodsA single‐site, cross‐sectional study was conducted at Townsville University Hospital in April 2022. Adult patients (aged 18 years and above) who underwent one of 10 specified diagnostic tests were included. The tests encompassed coagulation studies, urine cultures, blood cultures, cranial computed tomography (CT) in syncope, cranial CT in minor head injury, cervical spine CT in neck trauma, ankle X‐ray in acute ankle trauma, duplex lower extremity ultrasound in suspected deep vein thrombosis, CT pulmonary angiography in suspected pulmonary embolism, and CT kidney ureter bladder in renal colic. Tests were classified as low‐value based on Choosing Wisely recommendations, with their value determined by a research assistant using clinical documentation, prior to the availability of test results. Emergency clinicians were blinded to the study conduct.ResultsOf all diagnostic tests performed, 48.2% (276/572) were deemed low‐value, including 50.6% of laboratory tests (246/486) and 24.4% of imaging tests (21/86). The median ED length of stay was 6.1 h (IQR 3.9–8.5). Low‐value imaging tests contributed to 152 lost bed‐hours per 100 tests.ConclusionA substantial proportion of diagnostic tests were low‐value, exacerbating access block and reducing the availability of ED beds, thereby delaying timely emergency care. The implementation of evidence‐based, effective strategies is imperative to mitigate patient harm associated with low‐value diagnostic tests.

Minor head injuries and sprains are two types of injuries that frequently occur in the home, especially among vulnerable age groups such as toddlers and the elderly. Lack of public knowledge regarding the initial treatment of these injuries can result in delayed medical intervention and increase the risk of complications. This Community Service (PKM) activity aims to educate families on how to recognize, assess, and administer first aid for minor head injuries and sprains at home. The activity methods included interactive counseling, first aid simulations, discussions, and the distribution of educational media in the form of leaflets. The activity was conducted in Tamasaju Village, Takalar Regency, and involved 45 participants, consisting of parents of toddlers and family members caring for the elderly. Evaluation results showed an increase in participants' knowledge and skills in independently managing minor injuries. This activity is expected to increase family preparedness and reduce the risk of adverse effects from untreated injuries.

ABSTRACTRational, Aims and ObjectivesWhile low‐value care may have multiple contributing factors, it ultimately arises within patient‐physician interactions, often influenced by communication. This study examines whether and the extent to which physician communication factors influence patients' willingness to undergo low‐value care using hypothetical vignettes in South Korea.MethodsWe utilised data from a total of 1229 South Korean adults that included hypothetical vignettes on low‐value care. Participants were presented with vignettes involving minor head injury and the potential use of computed tomography (CT). We assessed changes in the proportion of individuals willing to undergo low‐value CT based on three physician communication factors: explicit recommendation, communication regarding test benefits and risks, and expressions indicative of defensive medicine, such as warning about missed problems and stating no legal responsibility. We also examined participant characteristics associated with their willingness to use low‐value CT.ResultsDecisions regarding low‐value care were significantly influenced by physician communication factors. For instance, while 68.5% of participants were willing to use low‐value CT without explicit recommendation, 76.6% were willing when an explicit recommendation was made. Among those initially willing to use low‐value CT without an explicit recommendation, 54.6% changed their decision and chose not to undergo the CT when presented with information on the risks and benefits. However, 69% of these individuals reversed their decision and opted for the CT when the vignette included elements indicative of defensive medicine. The willingness to use low‐value care was not associated with most participant characteristics, except for supplementary private health insurance and individual preferences for health care.ConclusionsPhysician communication plays a pivotal role in patient decision‐making regarding low‐value care. To reduce low‐value care, improving physician communication should be prioritised and considered a crucial leverage point in quality improvement initiatives.

Arachnoid cysts are benign congenital malformations typically located within the cerebrospinal fluid spaces of the brain. They are often asymptomatic and discovered incidentally. However, complications such as hemorrhage can render them clinically significant, especially following minor trauma. We present the case of a 19-year-old male who developed a progressive headache after mild head trauma. Neuroimaging revealed a right frontoparietal subacute subdural hematoma with significant midline shift. Unexpectedly, intraoperative findings revealed a hemorrhagic arachnoid cyst contributing to the mass effect. Surgical intervention involving hematoma evacuation and cyst fenestration led to complete symptom resolution. This case underscores the necessity of maintaining a high index of suspicion for arachnoid cyst complications even in cases of minor head injury and highlights the importance of timely surgical management to prevent neurological deterioration.

BackgroundChildhood stroke is a neurological emergency and an important cause of acquired brain injury and mortality in children. This retrospective study aimed to investigate the clinical presentation and neuroimaging features of arterial ischemic stroke (AIS) in children.MethodsWe retrospectively reviewed the records of pediatric AIS including neonates and children under 18 years of age from January 2008 to December 2023. Then we analyzed the gender and age distribution of AIS, as well as the clinical and neuroimaging characteristics and risk factors of AIS in different age groups. The study was approved by the Ethics Committee of the host institution.ResultsMale patients predominated in both the neonatal AIS (NAIS) group and the pediatric AIS (PAIS) group. The majority of AIS children (73, 60.33%) were diagnosed after 24 h of symptom onset. Seizures (82.35%) and limb weakness (77.88%) were the most common initial neurologic symptoms of NAIS and PAIS, respectively. Anterior circulation AIS alone was much more common than posterior circulation AIS alone in childhood AIS (79.34% vs. 9.92%). However, the NAIS group had a higher rate of infarctions that solely involved the cortex (52.94% vs. 20.19%). Perinatal hypoxia or asphyxia (23.5%) and minor head injury (28.85%) were the most common possible risk factors in NAIS and PAIS, respectively.ConclusionAIS in children is male-predominant, and there is significant diagnostic delay in both NAIS and PAIS. NAIS and PAIS differ in clinical and neuroimaging manifestations, and risk factors. Notably, we also noted that the actual prevalence of AIS in children, and the diagnosis of certain risk factors, may be underestimated. Education and training will be necessary in both layperson and healthcare settings. Furthermore, prospective studies are required to explore this hypothesis.