Traumatic brain injury in children part 1—initial assessment and management

Traumatic brain injury (TBI) is a significant health
issue in children and young adults. Although
most TBIs tend to be mild or moderate, TBI
is a leading cause of death or disability in children,
accounting for a quarter to one third of childhood
accidental deaths (Parslow et al, 2005; Durkin et al,
1998). Data suggest incidence rates of 100–300 per
100 000 children (British Society for Rehabilitation
Medicine, 1998; Hawley et al, 2003). However, rates
as high as 1000–3000 per 100 000 children per year
have been reported (McKinlay et al, 2008). Boys are at
greater risk of TBI compared to girls, and the risk of TBI
increases with age (Rivara, 1982; McKinlay et al, 2008).
Evidence also suggests that children who have sustained
a TBI are at increased risk of sustaining a subsequent
TBI (Swaine et al, 2007). Following assessment the
majority of children can be managed without admission
to hospital (Swann and Teasdale, 1999). Peak attendance
at A&E occurs during the winter when shorter daylight
hours increases the risk of accidents and during school
holidays when children are more likely to be playing
outside (Parslow et al 2005). This article will outline
the initial stabilisation of a child who has sustained a
TBI and the principles of pre-hospital management.
In addition, the role of the school nurse in relation to
the identification of TBI and accident prevention will
be discussed.