Clinical predictors of severe head trauma in children
H. Hennes, M. Lee, D. Smith, J. R. Sty and J. Losek
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
We reviewed the medical records of 55 patients who underwent a cranial
computed tomographic (CT) scan for acute head trauma. The severity of head
trauma was classified according to objective clinical findings as severe in
44 patients, moderate in three, and mild in eight. Thirty-seven patients
(84%) with severe head trauma had a brain injury identified on CT scan. Six
patients with severe head trauma had a Glasgow Coma Scale score of 12 or
greater and an abnormal CT scan. All patients with mild or moderate head
trauma had normal CT scans. Severe head trauma, as defined in this study,
accurately identified all patients with abnormal CT scan findings. We
conclude that a classification based on objective clinical findings
accurately identifies the severity of head trauma. This is particularly
important in evaluating patients with a Glasgow Coma Scale score of 12 or
greater. A prospective study including larger numbers of patients is needed
to further evaluate such a classification.
