Head injury in children

Abstract

Head injuries in children are frequently preventable. These injuries are usually the result of bicycle or motor vehicle accidents, abuse, or gun shot wounds. Maintenance of airway, breathing, and circulation immediately after the initial event may protect against ongoing cerebral damage. Despite these best efforts, brain injury often worsens after the initial insult (so called secondary brain injury). The pathophysiology of head injury has been more clearly delineated as a result of clinical and basic science research. It is still impossible to accurately predict, at the time of presentation, who will have a good and who will have a bad outcome. The focus of initial treatment is based on a sound understanding of cerebral pathophysiology, which is reviewed in this article. Maintenance of adequate cerebral blood flow and metabolism can be monitored by intracranial pressure monitors, jugular bulb catheter data, as well as noninvasive blood flow measurements. In the future, more specific pharmacologic agents will be available to prevent the sequence of events leading to secondary brain injury. A multidisciplinary approach to the treatment of the patients throughout their hospital and posthospital course is described. The hope is that early intervention and aggressive treatment will lead to improved outcome for children suffering head injury.