Problemi correnti
Il trauma cranico minore in Pronto Soccorso
Minor head trauma in the emergency room
Giovanna La Fauci1, Giuseppe Pagano2, Augusto Biasini2, Enrico Valletta1
1UO di Pediatria, Ospedale G.B. Morgagni - L. Pierantoni, AUSL di Forlì
2UO di Terapia Intensiva Neonatale e Pediatrica, Ospedale M. Bufalini, AUSL di Cesena
Settembre 2012 - pagg. 436 -441
Abstract
Head trauma is one of the most common causes of access to paediatric emergency services
and it is the leading cause of death and disability after the first year of life. However,
the approach to minor head injury (MHI), which by definition should be at low complication
risk, has a greater diversity in its management and it often leads to inappropriate use
of resources and diagnostic tools. The aim of this paper is to give some indications, according
to the available literature, to detect the small number of children with MHI that need
particular attention and to avoid unnecessary investigations and prolonged hospitalizations
to all others.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Da Dalt L, Andreola B, Facchin P, et al. Characteristics
of children with vomiting after minor
head trauma: a case-control study. J Pediatr
2007;150:274-8.
2. SIGN. Early management of a patient with a
head injury. 2009. http://www.sign.ac.uk/ pdf/sign110.
pdf.
3. Osmond MH, Klassen TP, Stiell IG, et al. CATCH
Study Group. The CATCH rule: a clinical decision
rule for the use of computed tomography
of the head in children with minor head injury
[abstract]. Acad Emerg Med 2006;13:S11.
4. Simpson D, Reilly P. Paediatric coma scale.
Lancet 1982;2:450.
5. Reilly P, Simpson D, Sprod R, et al. Assessing
the conscious level in infants and young children:
a paediatric version of the Glasgow Coma Scale.
Child’s Nerv Syst 1988;4:30-3.
6. Davis RL, Mullen N, Makela M, et al . Cranial
computed tomography scans in children after minimal
head injury with loss of consciousness.
Ann Emerg Med 1994;24:640-45.
7. Schutzman SA, Barnes P, Duhaime AC, et al.
Evaluation and management of children younger
than two years old with apparentely minor head
trauma: proposed guidelines. Pediatrics 2001;
107:983-93.
8. Lancon JA, Haines DE, Parent AD. Anatomy of
the shaken baby syndrome. Anat Rec 1998;253:
13-8.
9. Greenes DS, Schutzman SA. Clinical indicators
of intracranial injury in head injured infants. Pediatrics
1999;104:861-7.
10. Kuppermann N, Holmes JF, Dayan PS, et al.
Identification of children at very low risk of clinically
important brain injuries after head trauma: a
prospective cohort study. Lancet 2009;374:1160-70.
11. Greenes DS, Schutzman SA. Infants with isolated
skull fracture: what are their clinical characteristics,
and do they require hospitalization?
Ann Emerg Med 1997;30:253-9.
12. Committee on Quality Improvement, American
Academy of Pediatrics and Commission on
Clinical Policies and Research, American Academy
of Family Physicians. The management of
minor closed head injury in children. Pediatrics
1999;104:1407-15.
13. Palchak MJ, Holmes JF, Vance CW, et al. A
decision rule for identifying children at low risk
for brain injuries after blunt head trauma. Ann
Emerg Med 2003;42:492-506.
14. National Institute for Clinical Excellence.
Head injury. Triage, assessment, investigation
and early management of head injury in infants,
children and adults. 2007. http://www.nice.org.
uk/.
15. Dunning JP, Daly JP, Lomas JP, Lecky F, Batchelor
J, Mackway-Jones K. Derivation of the
children’s head injury algorithm for the prediction
of important clinical events decision rule for
head injury in children. Arch Dis Child 2006;91:
885-91.
16. Crowe L, Anderson V, Babl FE. Application of
the CHALICE clinical prediction rule for intracranial
injury in children outside the UK: impact
on head CT rate. Arch Dis Child 2010;95:1017-22.
17. Elliot RR, Sola Gutierrez Y, Harrison R, Richards
R, Cannon B, Witham F. Cautious observation
or blanket scanning? An investigation into
paediatric attendances to an emergency department
after head injury. Injury 2011;42:896-9.
18. Osmond MH, Klassen TP, Wells GA, et al.; Pediatric
Emergency Research Canada (PERC)
Head Injury Study Group. CATCH: a clinical decision
rule for the use of computed tomography
in children with minor head injury. CMAJ 2010;
182:341-8.
19. Pickering A, Harnan S, Fitzgerald P, Pandor A,
Goodacre S. Clinical decision rules for children
with minor head injury: a systematic review. Arch
Dis Child 2011;96:414-21.
20. Brenner DJ. Estimating cancer risk from pediatric
TC: going from qualitative to quantitative.
Pediatr Radiol 2002;32:228-31.
21. Brenner DJ, Hall EJ. Computed tomographyincreasing
source of radiation exposure. N Engl J
Med 2007;357:2277-84.
22. Pandor A, Goodacre S, Harnan S, et al. Diagnostic
management strategies for adults and
children with minor head injury: a systematic review
and an economic evaluation. Health Technol
Assess 2011;15:1-202.
23. Caviness AC. Skull Fractures in Children.
Uptodate 2011. http://www.uptodate.com/contents/
skull-fractures-in-children.
24. Da Dalt L, Marchi AG, Laudizi L, et al. Predictors
of intracranial injuries in children after
blunt head trauma. Eur J Pediatr 2006; 165:142-8.
25. Fleisher GR, Ludwig S (Eds). Textbook of Pediatric
Emergency Medicine, 6th Ed. 2010;37:
337-44. http://www.amazon.com/ Textbook-Pediatric-
Emergency-Medicine-Fleisher/dp/
1605471593.
26. Nigrovich LE, Lee LK, Hoyle J, et al. Prevalence
of clinically important traumatic brain injuries
in children with minor blunt head trauma
and isolated severe injury mechanisms. Arch Pediatr
Adolesc Med 2012;166:356-61.
27. Shutzman S. Minor head trauma in infant and
children. Sept 2011 Uptodate 19.3. http://www.
uptodate.com/contents/minor-head-trauma-ininfants-
and-children.
28. Greenes DS, Schutzman SA. Occult intracranial
injury in infants. Ann Emerg Med 1998;32:
680-6.
29. Nakahara K, Shimizu S, Utsuki S, et al. Linear
fractures occult on skull radiographs: a pitfall at
radiological screening for mild head injury. J
Trauma 2011;70:180-2.
Corrispondenza: g.lafauci@ausl.fo.it