TBI (Paed)

Question 1

Recite the TBI paediatric CPG - high risk component

Answer 1

Question 2

Recite the TBI paediatric CPG - moderate risk component

Answer 2

Question 3

Recite the TBI paediatric CPG - low risk component

Answer 3

Question 4

What defines a paediatric head injury as high risk?

Answer 4

Any of the following:
* Altered mental status (GCS < 15 or agitation)
* Penetrating head injury
* High risk features:
* LOC > 5 minutes
* Skull fracture
* Seizure (not including at time of impact)
* Worsening signs/symptoms
* Neurological deficit (e.g. numbness, weakness, abnormal gait, ataxia, clumsiness, double vision)

GCS refers to Glasgow Coma Scale, a scale used to assess consciousness in a person.

Question 5

How should high-risk paediatric head injuries be managed?

Answer 5

Follow CPG P0806 Major Trauma:
* Airway: Secure and maintain
* Breathing: Ensure adequate oxygenation and ventilation
* Circulation: Avoid hypotension if moderate-severe TBI is suspected
* Provide supportive care
* Transport: As per CPG P0105 Time Critical Guidelines

CPG refers to Clinical Practice Guidelines.

Question 6

What are moderate risk features in paediatric TBI?

Answer 6

Any of the following:
* Repetitive questioning
* Slow verbal responses
* Acting abnormally (if < 2 years)
* Dangerous MOI:
* Motor/cyclist impact > 30 km/h
* High speed MCA > 60 km/h
* Pedestrian impact
* Ejection from vehicle
* Prolonged extrication
* Fall from > 3 m
* Struck by object falling > 3 m
* Explosion
* Other factors:
* Intoxication
* Coagulopathy / anti-coagulant / antiplatelet (not aspirin)
* Severe headache
* Vomiting more than once
* LOC
* Non-frontal scalp haematoma (age < 2)
* Age < 6 months
* VP shunt
* Neurodevelopmental disorder

MOI refers to mechanism of injury.

Question 7

What is the disposition for moderate risk paediatric head injuries?

Answer 7

Transport: CT scan or observation is required. Consider VVED (Virtual Victorian ED) if:
* Only risk factors are:
* Multiple vomits
* Scalp haematomas
* Neurodevelopmental disorders
* No other concerning features present

VVED stands for Virtual Victorian Emergency Department.

Question 8

What defines a paediatric head injury as low risk?

Answer 8

No high or moderate risk criteria and a competent adult available to monitor for 4 hours

Monitoring is essential to observe for any delayed symptoms.

Question 9

How should a low risk head injury be managed?

Answer 9

If concussion symptoms present:
* Self-care
* Safety netting
* Health info sheet
* GP follow-up in 2–3 days
If no symptoms:
* Safety netting
* Health info sheet

Safety netting involves providing information about what to monitor for in case symptoms develop.