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Pediatric Head Trauma Differential Diagnoses

  • Author: Michael J Verive, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
Updated: Dec 31, 2015

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[27]
  • 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

Contributor Information and Disclosures

Michael J Verive, MD, FAAP Pediatrician, UP Health System Portage

Michael J Verive, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Society for Pediatric Sedation

Disclosure: Nothing to disclose.


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, American College of Chest Physicians

Disclosure: Nothing to disclose.

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, Wisconsin Medical Society

Disclosure: Nothing to disclose.


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.

  1. 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. 2009 Jun. 16(3):150-2. [Medline].

  2. 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. 2009 May 14. [Medline].

  3. Boggs W. Point-of-care ultrasound finds skull fractures in children. Medscape Medical News. May 24, 2013. Available at Accessed: June 3, 2013.

  4. Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW. Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children. Pediatrics. 2013 Jun. 131(6):e1757-64. [Medline].

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

  6. Hand L. Major causes of head trauma in children identified. Medscape Medical News. November 13, 2014. [Full Text].

  7. Quayle KS, Holmes JF, Kuppermann N, Powell EC, Mahajan P, Hoyle JD Jr, et al. Epidemiology of blunt head trauma in children in U.S. emergency departments. N Engl J Med. 2014 Nov 13. 371(20):1945-7. [Medline].

  8. Guilliams K, Wainwright MS. Pathophysiology and management of moderate and severe traumatic brain injury in children. J Child Neurol. 2016 Jan. 31 (1):35-45. [Medline].

  9. Toda N, Ayajiki K, Okamura T. Cerebral blood flow regulation by nitric oxide: recent advances. Pharmacol Rev. 2009 Mar. 61(1):62-97. [Medline].

  10. 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. 2009 Mar. 123(3):735-43. [Medline].

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

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

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

  14. 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). 2009 May 21. [Medline].

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

  16. 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. 2011 Aug. 46(8):1557-63. [Medline].

  17. Shein SL, Bell MJ, Kochanek PM, Tyler-Kabara EC, Wisniewski SR, Feldman K, et al. Risk Factors for Mortality in Children with Abusive Head Trauma. J Pediatr. 2012 May 11. [Medline].

  18. 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. 2010 Apr. 25(4):409-22. [Medline].

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

  20. Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings--part 1. J Neuroimaging. 2012 Apr. 22(2):e1-e17. [Medline].

  21. Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2. J Neuroimaging. 2012 Apr. 22(2):e18-41. [Medline].

  22. Prigatano GP, Gale SD. The current status of postconcussion syndrome. Curr Opin Psychiatry. 2011 May. 24(3):243-50. [Medline].

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

  24. [Guideline] First Comprehensive Pediatric Concussion Guidelines, Available Now. Medical Xpress. Jun 25 2014. [Full Text].

  25. Brunelle C, Hennecker JL, Scordidis V. [Loss of consciousness after a minor trauma revealing an aneurysm rupture in a child]. Arch Pediatr. 2012 Aug. 19(8):815-8. [Medline].

  26. Chelly H, Chaari A, Daoud E, et al. Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma. 2011 Oct. 71(4):838-46. [Medline].

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

  28. Leeper C, Nasr I, McKenna C, Berger RP, Gaines BA. Elevated admission INR strongly predicts mortality in victims of abusive head trauma. J Trauma Acute Care Surg. 2015 Dec 26. [Medline].

  29. Manzano S, Holzinger IB, Kellenberger CJ, et al. Diagnostic performance of S100B protein serum measurement in detecting intracranial injury in children with mild head trauma. Emerg Med J. 2016 Jan. 33 (1):42-6. [Medline].

  30. Papa L, Mittal MK, Ramirez J, et al. In children and youth with mild and moderate traumatic brain injury, glial fibrillary acidic protein out-performs s100β in detecting traumatic intracranial lesions on computed tomography. J Neurotrauma. 2016 Jan 1. 33 (1):58-64. [Medline].

  31. 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. 2009 Oct 3. 374(9696):1160-70. [Medline].

  32. Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012 Jan. 13 Suppl 1:S1-82. [Medline].

  33. [Guideline] Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May. 135 (5):e1337-54. [Medline].

  34. 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. 2011 Oct. 58(4):315-22. [Medline].

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

  36. Robinson N, Clancy M. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. Emerg Med J. 2001 Nov. 18(6):453-7. [Medline]. [Full Text].

  37. Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007 Mar. 8(2):138-44. [Medline].

  38. Brown CV, Sowery L, Curry E, et al. Recombinant factor VIIa to correct coagulopathy in patients with traumatic brain injury presenting to outlying facilities before transfer to the regional trauma center. Am Surg. 2012 Jan. 78(1):57-60. [Medline].

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

  40. Choe MC, Blume HK. Pediatric posttraumatic headache: a review. J Child Neurol. 2016 Jan. 31 (1):76-85. [Medline].

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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