Version June 2024
| Clinical features |
| Evaluate for SDH in victims of major head trauma with impaired consciousness or abnormal neurologic examination at any time after injury |
| Suspect inflicted head injury (Shaken baby syndrome) in infants ≤2 years of age with SDH and no plausible mechanism for head injury |
| Physical findings of SDH: irritability, vomiting, bulging anterior fontanelle, increased head circumference, pallor, lethargy, coma, or seizures |
| Findings of child abuse: retinal hemorrhages, skeletal or skull fractures with SDH (refer to UpToDate topics on child abuse) |
| Findings of cerebral herniation: lateralizing signs such as a fixed, dilated pupil and contralateral hemiparesis |
| Diagnostic evaluation |
| Determine GCS, identify pupillary abnormalities and lateralizing motor findings |
| Initial laboratory evaluation: complete blood count with platelets, PT, PTT, INR, bleeding time (if available), and type and cross |
| Obtain emergency brain imaging (eg, CT or fast MRI) |
| Lumbar puncture is contraindicated |
| Obtain neurosurgical consultation for all patients with GCS ≤12 or in patients with identified SDH |
| Make report of suspected child abuse, as indicated by physical findings, to the appropriate government agency according to local requirements and consult a child abuse team, if available |
| Ensure funduscopic examination by an ophthalmologist and perform skeletal survey in all children with suspected child abuse once clinically stabile |
| Treatment |
| Manage patient according to principles of advanced trauma life support*: |
| Immobilize cervical spine |
| Treat hypoxemia |
| Assess airway, breathing, circulation, and disability and initiate supportive care |
| Endotracheally intubate children with GCS ≤8 or rapidly worsening mental status |
| If impending herniation, provide hyperosmolar therapy (3% saline or mannitol, refer to UpToDate topics on the management of increased ICP in children) |
| Ensure definitive management by a neurosurgeon with pediatric expertise |
SDH: subdural hematoma; PT: prothrombin time; PTT: partial thromboplastin time; INR: international normalized ratio; CT: computed tomography; MRI: magnetic resonance imaging; GCS: Glasgow Coma Score; ICP: Intracranial pressure.
* Refer to UpToDate topics on trauma management in children.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
