Pediatric emergency medicine trisk 0817 0817
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CHAPTER 41 ■ INJURY: HEAD
SARA SCHUTZMAN, REBEKAH MANNIX
PEDIATRIC HEAD TRAUMA
Head injuries in children are common, accounting for approximately 500,000
emergency department (ED) visits per year in the United States. Although the
majority of these injuries are minor, head trauma causes significant pediatric
morbidity and mortality. Trauma is the leading cause of death in children older
than 1 year, and traumatic brain injury (TBI) is the leading cause of death and
disability caused by trauma in children, resulting in more than 2,000 deaths
annually.
The most common mechanism of injury for pediatric head trauma is falls,
followed by motor vehicle and pedestrian accidents and bicycle injuries; the
majority of fatal injuries occur secondary to motor vehicle–related accidents. The
mechanism of head injury varies with age; younger children are more likely to
suffer falls or abuse, whereas older children are often injured in sporting or motor
vehicle accidents (in addition to falls).
Many of the serious neurologic complications of head injury are evident soon
after the traumatic event; however, some life-threatening injuries can appear
initially as minor head trauma. To manage head injuries best, the physician must
approach the child in a systematic manner to address all injuries (global
resuscitation is the first priority of cerebral resuscitation), identify and treat any
neurologic complications, and prevent ongoing cerebral insult.
PATHOPHYSIOLOGY
Neurologic injury following head trauma is related to the unique physiology and
pathophysiology of the brain and the intracranial environment. The brain is a
semisolid structure bathed in cerebrospinal fluid (CSF) and covered by the fine
inner pia-arachnoid membrane and the outer thick fibrous layer of dura, all of
which are encased in the skull, which is covered by the five-layered structure of
the scalp. After infancy (when the skull sutures fuse), the cranial vault becomes a
stiff and poorly compliant structure housing the brain. Because the intracranial
volume is relatively fixed, any change in the volume of one of the intracranial
components (blood, brain, and CSF) must occur at the expense of the others; if
the other components do not decrease proportionally, intracranial pressure (ICP)
will increase.
