Initial approach to severe traumatic brain injury in children
- Monica S Vavilala, MD
Monica S Vavilala, MD
- Professor of Anesthesiology and Pediatrics
- University of Washington
- Pichaya Waitayawinyu, MD
Pichaya Waitayawinyu, MD
- Acting instructor, Department of Anesthesiology
- Faculty of Medicine, Mahidol University
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Injury is the leading cause of death for children and adolescents in the United States and most developed countries . Of these deaths, about 40 percent are the result of traumatic brain injury . Traumatic brain injury (TBI) is often associated with cervical spine injury .
The rapid identification and stabilization of children with severe traumatic brain injury is essential. Effective initial management of conditions that contribute to secondary brain injury (ie, hypoxia and hypotension) and prompt transfer to a facility that can provide pediatric trauma care are important determinants of outcome.
This topic will review the initial evaluation and management of children with severe traumatic brain injury (TBI). The evaluation and management of minor head injury, inflicted head injury, and elevated intracranial pressure are discussed separately. (See "Minor head trauma in infants and children: Evaluation" and "Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children" and "Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis".)
Severity of traumatic brain injury (TBI) is typically defined by the initial Glasgow Coma Scale (GCS) score. The GCS score is a widely used assessment of neurological function that has been validated in many studies since it was first introduced in 1976 . It has been modified for use in children (table 1).
Severity of TBI as determined by initial GCS score is as follows:
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- TYPES OF BRAIN INJURY
- ASSOCIATED INJURIES
- Physical examination
- - General assessment
- - Neurological assessment
- Laboratory studies
- Airway and breathing
- - Rapid sequence intubation
- - Ventilation
- Fluid management
- Other initial management considerations
- Initial management decisions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS