Radiography Skull There is no relevant literature or expert consensus regarding the use of skull radiographs in children with subacute head trauma and cognitive or neurologic signs. CT Head Patients with a significant change in neurologic status are at a high risk for progressive intracranial injury, may require neurosurgical intervention, and may benefit from imaging [43]. CT can provide rapid, accurate assessment for progressive hemorrhage, herniation, and hydrocephalus. In one study of 116 children with CT positive for Head Trauma-Child traumatic head injury, 9 patients experienced neurologic deterioration, 6 of whom required neurosurgery [44]. However, all patients undergoing intervention were identified clinically, without imaging, reflecting the importance of clinical examination in this population. CTA Head Imaging for vascular injury is primarily guided by clinical suspicion. Most literature regarding vascular injury in the pediatric population is confined to small series, and the true incidence and natural history of these injuries in children remains uncertain [19]. However, vascular imaging should be considered in patients with evidence of arterial stroke by examination or by imaging as well as those with fractures extending through the skull base vascular channels [37]. CTA provides high spatial resolution and rapid assessment for vascular injury. MRI Head MRI may be helpful in evaluating persistent, unexplained, or new neurological deficits in the subacute setting. MRI has a high sensitivity for blood products, including small brainstem and infratentorial hemorrhages as well as subacute hemorrhage, which becomes less dense on CT over time. The superior detection of nonhemorrhagic contusions and ischemia may be particularly helpful in the absence of findings on prior CT [38]. However, a standard MRI requires the patient be stable enough to tolerate a lengthier examination.
Head Trauma Child PCAs. Radiography Skull There is no relevant literature or expert consensus regarding the use of skull radiographs in children with subacute head trauma and cognitive or neurologic signs. CT Head Patients with a significant change in neurologic status are at a high risk for progressive intracranial injury, may require neurosurgical intervention, and may benefit from imaging [43]. CT can provide rapid, accurate assessment for progressive hemorrhage, herniation, and hydrocephalus. In one study of 116 children with CT positive for Head Trauma-Child traumatic head injury, 9 patients experienced neurologic deterioration, 6 of whom required neurosurgery [44]. However, all patients undergoing intervention were identified clinically, without imaging, reflecting the importance of clinical examination in this population. CTA Head Imaging for vascular injury is primarily guided by clinical suspicion. Most literature regarding vascular injury in the pediatric population is confined to small series, and the true incidence and natural history of these injuries in children remains uncertain [19]. However, vascular imaging should be considered in patients with evidence of arterial stroke by examination or by imaging as well as those with fractures extending through the skull base vascular channels [37]. CTA provides high spatial resolution and rapid assessment for vascular injury. MRI Head MRI may be helpful in evaluating persistent, unexplained, or new neurological deficits in the subacute setting. MRI has a high sensitivity for blood products, including small brainstem and infratentorial hemorrhages as well as subacute hemorrhage, which becomes less dense on CT over time. The superior detection of nonhemorrhagic contusions and ischemia may be particularly helpful in the absence of findings on prior CT [38]. However, a standard MRI requires the patient be stable enough to tolerate a lengthier examination.