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Utility of Emergency Department Observation Units for Neurologically Intact Children With Head CT Abnormalities Secondary to Acute Closed Head Injury

Lefort, Roxanna MD, MPH; Hunter, Jill V. I MBBS, FRCR (UK); Cruz, Andrea T. MD, MPH; Caviness, A. Chantal MD, MPH, PhD; Luerssen, Thomas G. MD; Adekunle-Ojo, Aderonke MBBS

doi: 10.1097/PEC.0000000000000863
Original Articles

Objective The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities.

Methods A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded. Medical records were abstracted for demographic, clinical, and radiographic findings. Poor outcome was defined as death, intensive care unit admission, or medically/surgically treated increased intracranial pressure.

Results Two hundred two children were included. Median (range) age was 14 (4 days-16 years) months; 51% were male. The most common CT findings were nondisplaced (136, 67%) or displaced (46, 23%) as well as skull fractures and subdural hematomas (38, 19%); 54 (27%) had less than 1 CT finding. The most common interventions included repeat CT (42, 21%), antiemetics (26, 13%), and pain medication (29, 14%). Eighty-nine percent were discharged in less than 24 hours. Inpatient admission from the EDOU occurred in 6 (3%); all were discharged in less than 3 days. One patient required additional intervention (corticosteroid therapy). She had a subdural hematoma, persistent vomiting, intractable headache, and a nonevolving CT.

Conclusions Neurologically intact patients on initial ED evaluation had a very low likelihood of requiring further interventions, irrespective of CT findings. Although prospective evidence is necessary, this supports reliance on clinical findings when evaluating a well-appearing child with an acute CHI.

From the *Sections of Emergency Medicine and Infectious Diseases, Departments of †Radiology, ‡Pediatrics, and §Neurosurgery, Baylor College of Medicine, Houston, TX.

Disclosure: The authors declare no conflict of interest.

Reprints: Aderonke O. Ojo, MD, 6621 Fannin St, Suite A2210, Houston, TX 77030 (e-mail:

The study was internally funded.

The data were presented in part as a poster at the Pediatric Academic Societies' Annual Meeting, Boston, MA, in April 2012.

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