Know Your Guidelines – Pediatric Head Trauma

Andrea Eberly, MD, MS, FAAEMEmergency Medicine, Guideline Knowledge Check, Medical News, Pediatric Emergency Medicine

Pediatric Head Trauma guidelines

Pediatric Head Trauma

Clinical Guideline Knowledge Check from Med-Challenger Medical Education

Since 2018, The Advanced Trauma Life Support Guidelines incorporate the Pediatric Emergency Care Applied Research Network (PECARN) criteria for brain imaging after pediatric head trauma. What are the salient PECARN points regarding pediatric head trauma?

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Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.

Try this review question and find out if you’re following the most current guidelines for Pediatric Head Trauma.

Case Question:

A 3-year-old girl and her 18-month-old brother tumble together down a long flight of concrete fire escape stairs at a hotel. Neither of the children lost consciousness or has vomited since the fall. Upon arrival at the emergency department, both appear alert. When offered a drink by the parents, both children reach purposefully for the container.

The boy is crying, intermittently consolable throughout the visit. The girl, sitting on her parent’s lap, responds verbally with appropriate answers and without delay to questions.

On physical examination, their vital signs are normal and neither child has periorbital or mastoid ecchymoses or a palpable skull fracture. The girl has a parietal 3 cm-palpable hematoma, whereas the boy as a 5-cm hematoma on the right side of the forehead.

The remainder of the neurologic exam is unremarkable for both of them. Both have a few superficial abrasions on the extremities without signs of fracture or other deeper injuries.

According to the Pediatric Emergency Care Applied Research Network (PECARN) criteria, which of the following statements is true regarding the management of these 2 siblings’ head injuries?

Answer Options:

A non-contrast head CT scan is indicated for both children.

Both children should be observed in the emergency department for 3 hours for neurological change.

The girl's parietal hematoma is an indication for a non-contrast head CT.

Ongoing crying, though intermittently consolable, is an indication for considering a non-contrast head CT for the boy.

Answer Explanation & References:

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About the Author:

Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.