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Management of minor head injury in children: searching for the answer
  1. Tina Sajjanhar
  1. Correspondence to Dr Tina Sajjanhar, Consultant in Paediatric Emergency Medicine, University Hospital Lewisham, London SE1 6LH, UK; tsajjanhar{at}nhs.net

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Introduction

Children presenting with minor head injury have always been of concern to emergency department clinicians; how to pick up the very small number of children who may have a significant intracranial injury (ICI), without overinvestigating (cost, risks of radiation, availability of 24 h radiology) and overadmitting (cost, inconvenience to family, limitations of observation). Ideally, there would be a robust clinical decision tree that would help clinicians to decide exactly which children to investigate and which children could be sent home safely. In reality, the management of these children is a combination of evidence-based guidance and clinical expertise, the intuition of an experienced clinician being invaluable. Guidelines will inevitably err on the side of caution, as missing even one case of significant ICI can have obvious devastating consequences.

NICE or not

Whether one agrees with the role of National Institute for Health and Clinical Excellence (NICE) or not,1 the first NICE guideline (2003) for head injury attempted to streamline management of the child, although many of the paediatric components were extrapolated from adult studies.2 The aim of reducing the number of skull x-rays and decreasing admissions has …

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