Emergency management of pediatric head injuries.

About a quarter of a million children are hospitalized each year in the United States because of head injuries, with many more than that treated outside the hospital. Although the majority of children with head trauma appear to recover fully, with or without treatment, a significant minority suffer neurologic residua and several thousand such children die annually. Thus, especially in more seriously injured children, the emergency treatment of the child may be crucial to the eventual outcome. In this review, an approach to the emergency management of pediatric head injuries is presented. The full assessment of the child--by means of a thorough history, physical and neurologic examinations, and appropriate diagnostic tests--is reviewed. The need to treat the whole child, searching for associated injuries of the spine, chest, abdomen, and limbs accompanying those to the head, is stressed. General supportive care of the child, including management of respiratory and circulatory systems, as well as specific treatment of raised intracranial pressure and post-traumatic seizures, is described. The clinical presentations of scalp injuries, skull fractures, cerebral concussion, cerebral contusion and laceration, and acute epidural and subdural hematomas are outlined and their treatments discussed.