Clinical predictors of severe head trauma in children.

We reviewed the medical records of 55 patients who underwent a cranial computed tomographic (CT) scan for acute head trauma. The severity of head trauma was classified according to objective clinical findings as severe in 44 patients, moderate in three, and mild in eight. Thirty-seven patients (84%) with severe head trauma had a brain injury identified on CT scan. Six patients with severe head trauma had a Glasgow Coma Scale score of 12 or greater and an abnormal CT scan. All patients with mild or moderate head trauma had normal CT scans. Severe head trauma, as defined in this study, accurately identified all patients with abnormal CT scan findings. We conclude that a classification based on objective clinical findings accurately identifies the severity of head trauma. This is particularly important in evaluating patients with a Glasgow Coma Scale score of 12 or greater. A prospective study including larger numbers of patients is needed to further evaluate such a classification.