5.1 Surgical Head Trauma Paediatric

Front 1

(Dunn)
In regards to Paediatric head injury, which of the following is incorrect?
A. Children are more prone to develop cerebral oedema than adults.
B. The large paediatric head produces greater rotational forces than the adult.
C. The CATCH and PECARN rules are "rule in" criteria for CT brain
D. The CHALICE criteria are "rule in" for CT brain.

Back 1

C.

Rule in = CATCH and CHALICE

Rule out = PECARN

Front 2

(Dunn)
In regards to Paediatric head injury

assessment, which of the following is correct?
A. The radiation risk for a 1 year old of a lifetime cancer is 1:500
B. The CHALICE rule is for age < 10
C. The PECARN decision rule is the only one that has been prospectively validated
D. The current rate of ordering CT brains in Australasia for Paediatric head injury is approximately 7%

Back 2

C. The Pecarn Rule has been Prospectively

validated.

A. 1:1500 [ 1: 1000 -1500 ]
B. Age < 16
D. 4%

Front 3

(Dunn)
In regards to Paediatric Head injury, which of the following is incorrect?
A. Signs of Increased ICP may be more subtle in infants with fontanelle.
B. 50% of infants with ICH will only have scalp haematoma as the single sign.
C. A significant scalp haematoma is "any" haematoma in age 1-2 year age group.
D. In age < 2 years, the indications for CT brain are the same as for Adults, but includes scalp haematoma.

Back 3

C. "Any" scalp haematoma in age < 1

in Age 1-2 years : = moderate-large size

Front 4

(Dunn)
In regards to Paediatric head injury, and

decision rules, which of the following is

incorrect?
A. CATCH and CHALICE are retrospectively validated.
B. The CHALICE decision rule has the lowest rate of CT ordering , at 4%
C. Current Australian Practice is to observe Children with a "low risk"

indication for CT, but to obtain CT imaging if deterioration occurs.
D. The PECARN rule is the only prospectively validated decision rule.

Back 4

B. 14%

Front 5

CHALICE = ?

Back 5

Children's Head injury Algorithm for the

Prediction of Important Clinical Events.

[ Should be "CHALPICE" ] easier to remember ..

Front 6

PECARN = ?

Back 6

Paediatric Emergency Care Applied Research Network

Front 7

Criteria for CT brain in Children < 2 years

Back 7

1. Abnormal mental status-

"not acting normally"
2. LOC > 5 seconds
3. Severe injury mechanism
4. Skull # (palpable)
5. Scalp Haematoma

99% sensitive for "Clinically important brain

injury".

Front 8

(Dunn)
In regards to the CHALICE criteria , which of the following is incorrect?
A. For head injury in age < 16 yrs
B. It is retrospectively derived.
C. It is 99% sensitive but 70% specific
D. It has a CT rate of 14% if followed ( Australian CT rate = 4%)

Back 8

C. 99% Sensitive

87% specific

Front 9

(Dunn)
In regards to the PECARN criteria for Paediatric Head Injury, which of the following is incorrect?
A. It is Prospectively validated-with a sensitivity of 97%.
B. Patients with no Criteria require no CT brain
C. Patients with one criteria MAY require a CT brain- BUT: Clinical

judgement is applied - more prolonged observation likely required.
D. Ground level falls are included.

Back 9

D. Trivial mechanisms are excluded:

- ground level fall
- running into object
- scalp abrasions / lacerations can be present present

Front 10

(Dunn)
In regards to the PECARN criteria, which of the following is incorrect?
A. Sensitivity = 97% (Age 2-18) 99% ( Age < 2)
B. Specificity is 60% ( 2-18) and 70% (< 2)

FOR CLINICALLY IMPORTANT BRAIN INJURY.
C. = Paediatric Emergency care Applied Research Network
D. GCS < 14 = an exclusion criterium.

Back 10

B. Age < 2 = Specificity of 54%

Front 11

List the 5 main signs of severe head injury.

Back 11

1. Decreased conscious state
2. Focal Neurology
3. Signs of increased ICP
4. Penetrating head injury
5. CSF leak (ears / nose)

Front 12

List the main features on Hx and Ex for

"moderate" head injury.

Back 12

History

1. Brief LOC
2. > 2 episodes vomiting
3. Brief seizure ( < 2 minutes)

Examination

1. Drowsy --> alert
2. Persistent headache
3. Large scalp haematoma / bruise
4. Otherwise normal examination

Front 13

List the features on History and Examination for "Mild" Head injury.

Back 13

History

1. No LOC
2. < 1 episode vomiting

Examination

1. Stable and alert
2. Small scalp haematoma / laceration
3. Otherwise normal examination

Front 14

(TheNNT.Com)
In regards to Minor Paediatric Head injury, which of the following is incorrect?
A. After 4-6 hours post injury for Minor head injury in age < 2 years, the risk of deterioration and requiring Neurosurgery is < 1:500.
B. 99.1% of Paediatric minor head injuries at initial examination will not require Neurosurgery.
C. 0.2 - 0.9 % of minor paediatric head injuries will require Neurosurgery.
D. 99.8% of Children upon initial examination for minor head injury, will not require Neurosurgery.

Back 14

D.

99.1 % at initial examination
99.8% at 4-6 hours post injury.

Front 15

TheNNT.Com
Which is incorrect regarding Paediatric Minor Head injury?
A. Frontal haematomas are "allowed" in classifying minor head injury in Children aged < 2 years.
B. A Parietal Scalp haematoma < 2 centimetres is considered significant in a 2 year old with minor head injury.
C. A very small proportion of children who appear neurologically normal will go on to have intracranial bleeding that will require Neurosurgery.
D. When minor head injury children do have Neurological deterioration, it is usually in the first few hours.

Back 15

B. A "large" scalp haematoma / bruising makes the head injury classification as

"moderate".

Age < 1 = bruise/laceration/swelling > 5 cm

Front 16

List the signs of increased intracranial

pressure (ICP) in Children.

Back 16

1. Vomiting
2. Headache
3. Irritability
4. Decreased level of consciousness