Management of moderate head injury in childhood: degree of consensus among Canadian pediatric emergency physicians.

The purpose of this study was to assess the degree of consensus among Canadian pediatric emergency physicians regarding the management of moderate head injury in children. A questionnaire regarding the management of moderate head injury in a child was developed, and it concentrated on indications for admission and policies regarding skull radiograph. The questionnaire was given to all pediatricians who are members of the Emergency Section of the Canadian Pediatric Society (n = 33) and who represent 15 Canadian pediatric emergency departments. The outcome was measured by the degree of consensus regarding management of children with moderate head injury. Twenty-three of 33 (70%) questionnaires, representing 14 of 15 (93%) emergency departments, were returned. Only five of 23 (22%) questionnaires report routinely admitting otherwise well children with short (three minutes or less) loss of consciousness; five (22%) routinely order a skull radiograph - three (13%) routinely do both. Certain clinical indicators led to 70 to 80% agreement regarding admission: severe headache, seizures, depressed skull fracture, and persistent vomiting. Agreement of more than 70% regarding indications for ordering a skull radiograph was achieved only for clinical suspicion of a depressed skull fracture. In conclusion, for the average child who is well after a loss of consciousness after a head injury lasting three minutes or less, the majority of respondents do not routinely admit the child or order a routine skull radiograph. A reasonable degree of consensus (70-80%) regarding ordering of skull radiographs and admission is based on clinical criteria.