SYNOPSIS

Head injury is one of the most frequent reasons for children presenting to emergency departments. Many terms are used – head injury, traumatic brain injury, concussion – often without clear delineation. Recently it seems that head injury presentations have increased, in addition to increased community and medical awareness of sports-related concussion. Head injuries raise a number of challenging issues in emergency departments. While the diagnosis of most injuries is straight forward, some seemingly mild injuries can have underlying clinically significant intracranial injuries. While CT scans are the gold standard for quick and definitive diagnosis, there is an increasing awareness of radiation-related brain cancers. While the majority of head injuries recover well a sizable minority of concussions go on to develop longer lasting sequelae and, at this time, there is no easy way to predict which children will have ongoing problems. Return-to-play and return-to-school should be graduated after head injury but approaches vary and are poorly evidence based. Finally, the evidence of poor on-field management raises questions about improving pre-hospital recognition and care of sports-related head injuries.

This talk presents a review of the literature on these topics and data from a number of completed or ongoing emergency department projects related to head injuries. This includes studies on clinical decision rules for the imaging of head injured patients; the on-field management of sports-related head injuries; the assessment of concussions; return to play in children after head injuries; and the development of a concussion clinic to provide both clinical care and as a research platform to identify and track children at risk of post-concussive symptoms

SPEAKER

A/Prof Franz Babl is an honorary associate professor in the Department of Paediatrics at The University of Melbourne and head of the emergency research group at Murdoch Childrens Research Institute. He is a paediatric emergency physician at The Royal Children’s Hospital and trained as a paediatrician and emergency physician. He is the principal investigator of an NHMRC funded multi-centre study to investigate clinical decision rules in the emergency department which has completed enrolment of 20,000 children with head injuries.