Pediatric Head Trauma Differential Diagnoses

  • Author: Arabela Stock, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 1, 2011
 
 

Diagnostic Considerations

The following diagnostic pitfalls are associated with head trauma:

  • Failure to recognize or suspect child abuse - One study suggests that certain combinations of clinical features may be suggestive of abusive head trauma, though a larger-scale prospective study would be required to develop a more refined tool[12]
  • Failure to recognize associated life-threatening injuries
  • Failure to recognize severe head injury that may initially seem less serious in a patient with multiple trauma - An example is the Waddell triad for a child pedestrian hit by a motor vehicle, which involves chest-abdomen trauma, leg injury, and a countercoup head injury

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Arabela Stock, MD  Consulting Staff, Department of Pediatrics, Division of Critical Care, All Children's Hospital

Arabela Stock, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Jagvir Singh, MD  Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge

Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Cakmakci H. Essentials of trauma: head and spine. Pediatr Radiol. Jun 2009;39 Suppl 3:391-405. [Medline].

  2. [Best Evidence] Yeates KO, Taylor HG, Rusin J, et al. Longitudinal trajectories of postconcussive symptoms in children with mild traumatic brain injuries and their relationship to acute clinical status. Pediatrics. Mar 2009;123(3):735-43. [Medline].

  3. Hymel KP, Stoiko MA, Herman BE, et al. Head injury depth as an indicator of causes and mechanisms. Pediatrics. Apr 2010;125(4):712-20. [Medline].

  4. Allard RH, van Merkesteyn JP, Baart JA. [Child abuse]. Ned Tijdschr Tandheelkd. Apr 2009;116(4):186-91. [Medline].

  5. Iranmanesh F. Outcome of head trauma in children. Indian J Pediatr. May 27 2009;[Medline].

  6. Garcia Garcia JJ, Manrique Martinez I, Trenchs Sainz de la Maza V, et al. [Registry of mild craniocerebral trauma: Multicentre study from the Spanish Association of Pediatric emergencies.]. An Pediatr (Barc). May 21 2009;[Medline].

  7. Mackerle Z, Gal P. Unusual penetrating head injury in children: personal experience and review of the literature. Childs Nerv Syst. May 19 2009;[Medline].

  8. Haider AH, Crompton JG, Oyetunji T, Risucci D, DiRusso S, Basdag H, et al. Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies. J Pediatr Surg. Aug 2011;46(8):1557-63. [Medline].

  9. Kapapa T, Pfister U, Konig K, et al. Head trauma in children, part 3: clinical and psychosocial outcome after head trauma in children. J Child Neurol. Apr 2010;25(4):409-22. [Medline].

  10. Ley EJ, Srour MK, Clond MA, et al. Diabetic patients with traumatic brain injury: insulin deficiency is associated with increased mortality. J Trauma. May 2011;70(5):1141-4. [Medline].

  11. Rangarajan N, Kamalakkannan SB, Hasija V, et al. Finite element model of ocular injury in abusive head trauma. J AAPOS. May 4 2009;[Medline].

  12. Maguire SA, Kemp AM, Lumb RC, Farewell DM. Estimating the Probability of Abusive Head Trauma: A Pooled Analysis. Pediatrics. Aug 15 2011;[Medline].

  13. Trenchs V, Curcoy AI, Castillo M, et al. Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?. Eur J Emerg Med. Jun 2009;16(3):150-2. [Medline].

  14. Ringl H, Schernthaner R, Philipp MO, et al. Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms. Eur Radiol. May 14 2009;[Medline].

  15. Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. Oct 3 2009;374(9696):1160-70. [Medline].

  16. [Guideline] Davis PC, Seidenwurm DJ, Brunberg JA, et al. Head trauma. American College of Radiology (ACR). 2006.

  17. [Guideline] Kellogg ND. Evaluation of suspected child physical abuse. Pediatrics. Jun 2007;119(6):1232-41. [Medline]. [Full Text].

  18. Holmes JF, Borgialli DA, Nadel FM, et al. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation?. Ann Emerg Med. Oct 2011;58(4):315-22. [Medline].

  19. Thomas M, Haas TS, Doerer JJ, et al. Epidemiology of sudden death in young, competitive athletes due to blunt trauma. Pediatrics. Jul 2011;128(1):e1-8. [Medline].

 
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Epidural hematoma with midline shift.
Subdural hematoma.
Intraventricular hemorrhage.
Epidural hematoma with acute neurologic deterioration.
Table 1. Pediatric Glasgow Coma Scale: Eye Opening
Score≥1 Year0-1 Year
4Opens eyes spontaneouslyOpens eyes spontaneously
3Opens eyes to a verbal commandOpens eyes to a shout
2Opens eyes in response to painOpens eyes in response to pain
1No responseNo response
Table 2. Pediatric Glasgow Coma Scale: Best Motor Response
Score≥1 Year0-1 Year
6Obeys commandN/A
5Localizes painLocalizes pain
4Flexion withdrawalFlexion withdrawal
3Flexion abnormal (decorticate)Flexion abnormal (decorticate)
2Extension (decerebrate)Extension (decerebrate)
1No responseNo response
Table 3. Pediatric Glasgow Coma Scale: Best Verbal Response
Score> 5 Years2-5 Years0-2 Years
5Oriented and able to converseUses appropriate wordsCries appropriately
4Disoriented and able to converseUses inappropriate wordsCries
3Uses inappropriate wordsCries and/or screamsCries and/or screams inappropriately
2Makes incomprehensible soundsGruntsGrunts
1No responseNo responseNo response
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