The assessment of child with head injury may be difficult. Some children with a seemingly mild head injury and a Glasgow Coma Score >= 12 can have abnormal findings on head CT scan. Hennes et al developed clinical criteria for classifying head injury in children, which can help guide clinical evaluation and use of imaging studies.



(1) altered mental status

(2) evidence of increased intracranial pressure

(3) seizure or focal neurologic deficit

(4) scalp or facial injuries




altered mental status

(1) history or finding of unresponsiveness; OR (2) inappropriate motor response to verbal or painful stimuli

evidence of increased intracranial pressure

(1) presence of persistent and/or progressive headache, OR (2)persistent vomiting

seizure or focal neurologic deficit

(1) seizure OR (2) focal neurologic deficit

scalp and/or facial injuries

facial or scalp hematoma, contusion and/or laceration



Parameters Present

Degree of Injury



scalp and/or facial injuries only


altered mental status and/or increased intracranial pressure and/or seizure/deficit



Findings indicating an abnormal CT scan:

(1) areas of increased or decreased density

(2) midline shift

(3) loss of gray matter-white matter differentiation

(4) signs of herniation


Correlation with CT scan findings:

• All patients with mild or moderate injury had normal CT scan findings.

• 84% of children with severe injury had an abnormal CT scan.

• 6 of the children with severe injury and an abnormal CT scan had a Glasgow coma score >= 12.


NOTE: In the spreadsheet I added a GCS < 12 as an indication for a complete evaluation. This may be unnecessary, since a reduced GCS would usually be associated with an altered mental status.


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