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New emergency response to head injuries in children

“You don’t want to miss an injury and you don’t want to do too many scans,″⁣ Professor Babl told The Age.

“The doctors and nurse practitioners who are ordering these scans are trying to do right and, sometimes, it is a real struggle to get that balance.”

Professor Franz Babl says clinicians need to balance the use of CT scans with the risks of exposing children to radiation.

Professor Franz Babl says clinicians need to balance the use of CT scans with the risks of exposing children to radiation.

The full guidelines run to 250 pages. An accompanying flow chart summary provides a visual checklist for clinicians either triaging, diagnosing or treating children when they present with head injuries.

The guidelines are primarily targeted at emergency department staff but Professor Babl said they could also help team doctors and school nurses in their initial response to children who injure their heads playing sport or at school.

Matthew Salter, whose teenage son Jakob sustained a concussion late last year after mistiming a BMX jump, welcomed the move towards greater consistency in treatment.

Mr Salter took Jakob, 15, to the Royal Children’s Hospital after he found him at their local bike track with his face bloodied and helmet smashed. The family has since moved to a semi-rural property where Jakob is building his own mountain bike run.

Although Jakob’s initial concern was his teeth, he started vomiting while under observation in hospital.

“It gave us a lot of confidence to know we were so close to the Children’s and we had that degree of support,″⁣ Mr Salter said. “With head injuries you can’t mess with them. I think those guidelines are vital.″⁣

Jakob Salter, recovered from his head injury, takes a jump at his family’s Monbulk property.

Jakob Salter, recovered from his head injury, takes a jump at his family’s Monbulk property.Credit:Penny Stephens

About 4 per cent of all children who present to an emergency department in Australia and New Zealand have head injuries.


CT scans are routinely used to detect potentially life-threatening injuries inside the skull, such as brain bleeds. However, these intracranial injuries are found in only 2 per cent of all children with head injuries.

University of Auckland Professor Stuart Dalziel, a senior member of the research team, said it could be particularly difficult to identify brain trauma in children who presented with seemingly mild head injuries.

A more common problem, even in children with mild to moderate head injuries, is post-concussive symptoms.

Professor Babl, the leader of emergency research at the MCRI, said these ranged from headaches and dizziness to difficulties in sleeping, studying and moderating emotions. They could persist for days or weeks after an injury.

Post-concussive symptoms affect more than a third of all children with head injuries.

Professor Babl said recent studies suggested some children recovering from head injuries benefited from an earlier return to school and sport than doctors previously advised.


“When you look at the rate of post-concussive symptoms, we think a follow-up for kids who have concussion or concussive symptoms is reasonable to make sure they are caught early,″⁣ he said.

“In the past there was much more focus on strict rest. We have really moved away from this. If children are tolerating non-contact exercise, if they are tolerating cognitive activity that doesn’t make the symptoms worse, they can progress back to normal fairly quickly.″⁣

The full guidelines are published by PREDICT, the Paediatric Research in Emergency Departments International Collaborative. Professor Babl said his team was developing a separate resource for parents, based on the guidelines, to explain the treatment of head injuries and effect of CT scan radiation on children.

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