Primary Care Perspectives: Episode 125 - Emergency Room or Not?
May 16, 2022
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Daniel Corwin, an emergency medicine physician at Children’s Hospital of Philadelphia, dives into the crucial topic of pediatric head trauma. He discusses the distinctive criteria for assessing children under two, revealing why they differ from older kids. Corwin explains the importance of evaluating injury mechanisms and offers practical guidelines for parents on monitoring their child after a head injury. He also sheds light on recent changes in concussion management, emphasizing a more supportive approach to recovery for young patients.
Understanding specific criteria for assessing head trauma in children under 2 years old is crucial for safe management decisions.
Recognizing symptoms of concussion in children over 5 years old enables tailored recovery strategies and timely referrals to specialists.
Deep dives
Understanding Acute Head Injuries
Acute head injuries are defined as injuries occurring within 24 hours and encompass various types of trauma that are not abuse-related. The classification of patients into two age groups—under 2 years and over 2 years—is crucial for assessing the risk of severe injuries. Children under 2 years are often preverbal, which complicates the ability to communicate symptoms, while their anatomical differences make them more vulnerable to injury. Additionally, exposure to ionizing radiation from CT scans poses long-term risks for younger children, underscoring the need for specific evaluation criteria based on age.
Risk Assessment Criteria
For younger children, a study established six criteria to assess the low risk of intracranial injury after a head trauma. These criteria include normal mental status, absence of a palpable skull fracture, and a non-severe injury mechanism, such as minor falls or bumps. The study revealed that among over 1,200 children who met all low-risk criteria, none exhibited clinically significant traumatic brain injuries. This finding supports the decision to avoid unnecessary imaging and emergency department visits, provided the criteria are met.
Concussion Evaluation and Management
In children over the age of 5, acute head injuries may lead to concussions, and recognizing initial signs is vital for proper management. Common symptoms to look for include cognitive challenges, physical discomfort, and emotional changes that can arise days after the injury. A thorough visio-vestibular exam is recommended to evaluate various symptoms and assess balance, eye movements, and cognition, all of which can provide crucial insights into a child's condition. This comprehensive approach allows practitioners to tailor recovery strategies based on the specific deficits presented by each child.
Post-Injury Guidance and Follow-Up
Following an acute head injury, it's important to provide parents with clear guidance about monitoring their child's condition in the days that follow. Generally, children showing improvement should be encouraged to engage in light activities and gradually return to school, ideally within 48 hours post-injury. However, for children exhibiting persistent or worsening symptoms, prompt follow-up with primary care is necessary to determine if a referral to a concussion specialist is warranted. This proactive approach facilitates early access to rehabilitation therapies, enhancing the likelihood of a full recovery.