The great majority of TBIs are classified as mild; only 2-5% of these are associated with intracranial injuries (ICI) and only 1-2% require neurosurgical intervention. In fact, 90% of CTs in adults with minor head injuries are negative. However, it may be difficult to decide on clinical grounds which patient with a minor TBI should have a head CT. In addition, there is concern about costs and unnecessary radiation exposure, as well as a need for sedation in many pediatric patients in order to do a CT. Clinical algorithms have been developed in both adults and children to better predict the need for a CT in patients with a minor TBI.
In 1999, the AAP issued a Practice Parameter governing the management of minor TBI in children. It specifically referred to previously neurologically normal children, 2-20 years old, who at the time of the initial evaluation had:
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These patients may have had a brief LOC (< 1 min) or a seizure immediately after the injury, may have vomited after injury or may have had headache or lethargy, as long as they were normal, by the above criteria, at the time of the initial exam.
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