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Infants with intracranial injuries may have limited neurologic
findings and appear asymptomatic.
Clinical assessment of infants may be challenging.
Index of suspicion for nonaccidental trauma should be low.
Goal of Treatment
The primary goal in the evaluation of any patient who has sustained a blunt
head injury is to determine the severity of the injury and identify ciTBI. As
with all trauma evaluations, the initial goal of treatment is immediate
stabilization.
Current Evidence. Neurotrauma is one of the most common reasons for
ED evaluation with more than 800,000 annual visits by children. ED visits
for younger children up to 4 years of age have increased significantly in the
past several years. Common mechanisms of injury include falls, being
unintentionally struck by or against an object, motor vehicle collisions
either as a passenger or pedestrian struck by, bicycle accidents, sportsrelated, assaults, and nonaccidental trauma. A detailed description of
anatomy, pathophysiology, and causes of increased intracranial pressure
(ICP) is included in Chapter 41 Injury: Head .
Briefly, the spectrum of traumatic brain injury (TBI) patterns range from
minor head injury, concussion, skull fracture, pneumocephalus, intracranial
hematoma, cerebral edema, diffuse axonal injury (DAI), cerebral herniation
to death. Cerebral hematomas may be extra-axial, occurring in the epidural
or subdural space or intra-axial, occurring within the parenchyma of the
brain. Most recent studies have separated intracranial injury from ciTBI.
The definition of ciTBI includes the presence of a depressed skull fracture
necessitating surgical elevation, neurosurgical intervention including, but
not limited to, invasive ICP monitoring, ventriculostomy, hematoma
evacuation and/or decompressive craniectomy, endotracheal intubation for
more than 24 hours, hospital admission for 48 hours or more, and death.
Utilizing this definition, the overall incidence of ciTBI ranges from 0.02%
to 4.4%.