Variation in specialists' reported hospitalization practices of children sustaining blunt head trauma.

Introduction: Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.

Methods: WE SURVEYED PEDIATRIC AND GENERAL EMERGENCY PHYSICIANS (EP), PEDIATRIC NEUROSURGEONS (PNSURG), GENERAL NEUROSURGEONS (GNSURG), PEDIATRIC SURGEONS (PSURG) AND TRAUMA SURGEONS REGARDING CARE OF TWO HYPOTHETICAL PATIENTS: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet.

Clinician judgment versus a decision rule for identifying children at risk of traumatic brain injury on computed tomography after blunt head trauma.

Objective: To compare a decision rule with clinician judgment for identifying children at risk of traumatic brain injury (TBI) after blunt head trauma.

Methods: We performed an observational study of children with blunt head trauma. Emergency department physicians documented suspicion for TBI before cranial computed tomography (CT), rating suspicion as very low, low, intermediate, or high.

Performance of the pediatric glasgow coma scale in children with blunt head trauma.

Objectives: To compare the accuracy of a pediatric Glasgow Coma Scale (GCS) score in preverbal children with blunt head trauma with the standard GCS score in older children.

Methods: The authors prospectively enrolled children younger than 18 years with blunt head trauma. Patients were divided into cohorts of those 2 years and younger and those older than 2 years.

Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?

Background: A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma.

Objective: We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma.

Methods: We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma.

Do children require hospitalization after immediate posttraumatic seizures?

Study Objective: We determine whether children with immediate posttraumatic seizures require hospitalization for observation of possible neurologic complications.

Methods: This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning.

A randomized, double-blinded, placebo-controlled trial of phenytoin for the prevention of early posttraumatic seizures in children with moderate to severe blunt head injury.

Study Objective: We determine the efficacy of prophylactic phenytoin in preventing early posttraumatic seizures in children with moderate to severe blunt head injury.

Methods: Children younger than 16 years and experiencing moderate to severe blunt head injury were randomized to receive phenytoin or placebo within 60 minutes of presentation at 3 pediatric trauma centers. The primary endpoint was posttraumatic seizures within 48 hours; secondary endpoints were survival and neurologic outcome 30 days after injury.

A decision rule for identifying children at low risk for brain injuries after blunt head trauma.

Study Objective: Computed tomography (CT) is frequently used in evaluating children with blunt head trauma. Routine use of CT, however, has disadvantages. Therefore, we sought to derive a decision rule for identifying children at low risk for traumatic brain injuries.

Identification of children with intra-abdominal injuries after blunt trauma.

Study Objective: We sought to determine the utility of laboratory testing after adjusting for physical examination findings in the identification of children with intra-abdominal injuries after blunt trauma.

Methods: The study was a prospective observational series of children younger than 16 years old who sustained blunt trauma and were at risk for intra-abdominal injuries during a 2(1/2)-year period at an urban Level I trauma center. Patients were examined by faculty emergency physicians and underwent standardized laboratory testing.