- In children, diffuse injuries are proportionally more common whereas, in adults, focal injuries such as epidural and subdural hematomas and cerebral contusions are more common.
- Compared to adults, skull fractures in children are more common but less frequently associated with underlying brain injury.
- A growing fracture can present months on the injury and requires neurosurgical repair. It can occur when the leptomeninges are torn beneath the fracture, leading to a CSF leptomeningeal cyst that forces apart the fracture edges and leads to nonunion. Growing skull fractures typically present weeks to months following an injury resulting in skull fracture.
Epidural hematoma - Collection of blood between the inner skull and the dura. Usually results from rapid arterial bleeding from the middle meningeal artery or the dural or diploic vasculature. Generally good prognosis if surgical evacuation can be done in a timely fashion.
Subarachnoid hemorrhage - Often associated with significant trauma and diffuse axonal injury (DAI). Children with DAI present with a depressed level of consciousness with a normal appearing CT scan.
Mechanism, Time of the incident
LOC, seizure, changes in behavior, or vomiting, ENT Bleed
Medications, Previous Head trauma
Suspect NAI if the history is incompatible with the child’s age
- Head - Inspect, Palpate, Check Fontanelles
- ENT Exam
- Maxillofacial Exam
- Neck exam
- Quick Head to toe exam
- CHALICE (Children’s Head Injury Algorithm for the Prediction of Important Clinical Events)
- CATCH (Canadian Assessment of Tomography for Childhood Head Injury)
- PECARN (Pediatric Emergency Care Applied Research Network)
- NICE guidelines