The clinical predictors of severe head trauma in 55 children, 1 to 15 years of age, were compared with CT scan findings at the Dept of Pediatrics, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, WI. Severity of head trauma was determined according to the presence or absence of clinical variables, including altered mental states, duration of loss of consciousness or 5 min, vomiting, headache, focal neurologic deficit, seizure, and soft-tissue injury. Injury was considered severe if one or more of the following variables were present: altered mental status, increased intracranial pressure, and seizure or focal neurologic deficit. Thirty-seven (84%) of 44 patients with severe head trauma had a positive CT scan. Six (13%) with a Glasgow Coma Scale (GCS) score of 12 or greater had abnormal CT scans. All patients with mild or moderate head trauma had normal CT scans. Historical information and clinical examination were the most accurate predictors for abnormal CT scans regardless of GCS scores. [1]

COMMENT. The GCS may have limited application in the evaluation of acute head trauma in the pediatric population. A classification based on clinical findings more accurately identifies the severity of head trauma and the need for CT scans.

A further clinical objective evaluation of children with acute head injury includes tests of neuropsychological function. Investigators from the Dept Pediatrics, Univ of Maryland, Baltimore, report cognitive deficits immediately after closed head injury in adolescents that may interfere with school, home and peer activities. [2]