CT may be considered in lieu of careful clinical observation in instances of parental preference, multiple risk factors, worsening clinical symptoms or signs during observation, and in young infants in which observational assessment is more challenging. Head Trauma-Child CTA Head There is no relevant literature or expert consensus supporting the use of CTA in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. MRI Head MRI is sensitive for acute intracranial hemorrhage and other intracranial traumatic injury. However, MRI in the acute setting is frequently impractical. The examination requires preimaging safety screening, is significantly longer than CT, and younger children often need sedation to compete the examination, further delaying time to imaging. IV contrast is typically of little use in evaluation of acute trauma. MRA Head There is no relevant literature or expert consensus supporting the use of MRA in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. Arteriography Cerebral There is no relevant literature or expert consensus supporting the use of conventional cerebral angiography in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. Variant 3: Child. Minor acute blunt head trauma. High risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. High-risk factors for intracranial injury from minor head trauma in children <2 years of age by PECARN criteria include those with a GCS of 14, other signs of altered mental status, or signs of any palpable skull fracture.
Head Trauma Child PCAs. CT may be considered in lieu of careful clinical observation in instances of parental preference, multiple risk factors, worsening clinical symptoms or signs during observation, and in young infants in which observational assessment is more challenging. Head Trauma-Child CTA Head There is no relevant literature or expert consensus supporting the use of CTA in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. MRI Head MRI is sensitive for acute intracranial hemorrhage and other intracranial traumatic injury. However, MRI in the acute setting is frequently impractical. The examination requires preimaging safety screening, is significantly longer than CT, and younger children often need sedation to compete the examination, further delaying time to imaging. IV contrast is typically of little use in evaluation of acute trauma. MRA Head There is no relevant literature or expert consensus supporting the use of MRA in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. Arteriography Cerebral There is no relevant literature or expert consensus supporting the use of conventional cerebral angiography in the initial evaluation of children with minor head injury and intermediate risk for intracranial injury. Variant 3: Child. Minor acute blunt head trauma. High risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. High-risk factors for intracranial injury from minor head trauma in children <2 years of age by PECARN criteria include those with a GCS of 14, other signs of altered mental status, or signs of any palpable skull fracture.