Accidental trauma of infancy: emergency department evaluation and management

Abstract

The common mechanisms and injury patterns of accidental trauma in infants differ from those of older children and adults, with falls representing the most common etiology. While the evaluation of traumatic injury in infants should follow an algorithm similar to that used for adults, the unique pediatric physiologic response to trauma must be taken into consideration. In addition, the utility of certain imaging studies in these patients is highly case specific, particularly with minor head injuries. This supplement reviews the evaluation and management of infants with accidental traumatic injury, including the most common circumstances and pathophysiology of injury, the differential diagnosis of the infant trauma victim, and the workup and management of accidental injuries in this patient population.

Figure 1.. Imaging Recommendations for Patients Aged <2 Years With Apparently Minor Head Trauma

^aExclusion criteria: birth trauma, penetrating injury, pre-existing neurologic disorder, bleeding diathesis, intracranial shunt, multiple trauma, or if significant concern for abuse/neglect on initial evaluation. ^bDischarge may be considered (after appropriate evaluation, with imaging, observation, or neurosurgical consultation as indicated) if: (1) the child has no significant extracranial injuries or other indications (eg, unremitting vomiting) for admission; (2) the child easily alerts and has a normal neurologic examination; (3) there is no suspicion of abuse or neglect; and (4) the child lives in relatively close proximity to healthcare and has reliable caretakers who are able to return if necessary. Reproduced with permission from Pediatrics, Vol. 107, Page 990, Copyright ©2001 by the AAP. Abbreviations: CT, computed tomography; LOC, loss of consciousness; MVC, motor vehicle collision.