Patient selection: pediatric patient with blunt head injury
Outcome: ordering of head CT
Criteria for pediatric patients - one or more of the following:
(1) evidence of skull fracture (basilar, depressed, diastatic, etc)
(2) scalp hematoma (over the calvarium; do not include hematomas of face or neck)
(3) neurologic deficit (motor or sensory deficits, cerebellar signs, abnormal gait, abnormal weakness, etc)
(4) abnormal level of alertness (Glasgow coma score <= 14, delayed or inappropriate response to external stimulus, excessive somnolence, disorientation, inability to remember 3 objects at 5 minutes; perseverating speech, etc)
(5) abnormal behavior (inappropriate action, agitation, inconsolability, refusal to cooperate, etc)
(6) persistent vomiting (>= 2 episodes of projectile or forceful emesis)
(7) coagulopathy (impairment of normal clotting)
where:
• Signs of basilar skull fracture: periorbital or periauricular ecchymoses; hemotympanum; drainage of CSF from nose or ears
• Signs of depressed skull fracture: palpable step-off of the skull; stellate laceration; injury from an object striking a localized region of the skull
A pediatric patient with none of the criteria is unlikely to have a "significant" finding on head CT. This does not mean that the head CT would be completely normal.
