Minor head injury in children.

PURPOSE OF REVIEW: This review will examine mild closed head injury (CHI) and the current evidence on head computed tomography (CT) imaging risks in children, prediction rules to guide decisions on CT scan use, and issues of concussion after initial evaluation. RECENT FINDINGS: The current literature offers preliminary evidence on the risks of radiation exposure from CT scans in children. A recent study introduces a validated prediction rule for use in mild CHI, to limit the number of CT scans performed. Concurrent with this progress, fast (or short sequence) MRI represents an emerging technology that may prove to be a viable alternative to CT scan use in certain cases of mild CHI where imaging is desired. The initial emergency department evaluation for mild CHI is the start point for a sequence of follow-up to assure that postconcussive symptoms fully resolve. The literature on sports-related concussion offers some information that may be used for patients with non-sports-related concussion. SUMMARY: It is clear that CT scan use should be as safe and limited in scope as possible for children. Common decisions on the use of CT imaging for mild head injury can now be guided by a prediction rule for clinically important traumatic brain injury. Parameters for the follow-up care of patients with mild CHI after emergency department discharge are needed in the future to assure that postconcussive symptoms are adequately screened for full resolution.

Does a pain scale improve pain assessment in the pediatric emergency department?

OBJECTIVE: Pain management in children requires rapid and sensitive assessment. The Wong-Baker FACES pain scale (WBFPS) is a widely accepted, validated tool to assess pain in children. Our objective was to determine whether incorporation of the WBFPS into the emergency medical record (EMR) improves pain documentation in the pediatric emergency department. We also examined whether this intervention improves the management of children who present with pain. METHODS: The WBFPS was incorporated into the EMR in an urban tertiary care pediatric emergency department. We performed a review of EMRs for patients aged 3 to 20 years at 30 days before and 30 days after the intervention. All physicians were trained to use the WBFPS. We excluded patients younger than 3 years or who were unable to perform the assessment. We compare rates of pain score documentation for the preintervention (PRE) and postintervention (POST) groups and times from triage to analgesia administration using Fisher exact test. RESULTS: A total of 462 and 372 EMRs were included in the PRE and POST groups, respectively. The groups were similar with respect to age (P = 0.46); there were more males in the POST group (47.2% vs 56.5%, P = 0.008). The rate of pain score documentation was 7.4% (n = 34) in the PRE group and 38.2% (n = 142) in the POST group (P < 0.001). In patients with pain score of 6 or greater, there was no statistical difference in analgesia administration (PRE, 41.7% [10/24] vs POST, 41.8% [28/67]) or time to administer analgesia in minutes (PRE, 80.4%; median, 42 and POST, 100.5%; median, 52.5; P = 0.71). CONCLUSIONS: Incorporating the WBFPS into the EMR significantly improves pain assessment in children. Despite this, there was neither improvement in analgesia administration nor reduction in time to administer analgesia in children with pain.