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Clinical Pediatrics
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Symptomatic Blunt Head Injury in Children—A Prospective, Single-Investigator Study

Jay D. Fisher, MD

Pediatric Emergency Services, University Medical Center of Southern Nevada, University of Nevada School of Medicine, Las Vegas, Nevada

The goal of this study was to describe a single emergency physician's experience with symptomatic blunt head injury in children and prospectively assess the sensitivity and predictive value of the neurologic examination. The author utilized a prospective patient series comparing neurologic examination with computed tomography (CT) of the head. Nine of 42 patients had intracranial injury for a prevalence of 21%; two patients (5%) had intracranial injury with only subtle neurologic examination findings. Twenty-six patients had a negative neurologic examination, and all had normal-appearing CT scans. Sixteen patients had a positive neurologic examination, of whom nine had a positive CT scan. The properties of the neurologic examination as a diagnostic test, with CT as the gold standard, were as follows: sensitivity = 100%, specificity = 78%, positive predictive value = 56%, negative predictive value = 100%. Normal findings from neurologic examination can be used in some children with symptomatic blunt head injury to delay or eliminate the need for CT of the head.

Clinical Pediatrics, Vol. 36, No. 8, 461-465 (1997)
DOI: 10.1177/000992289703600805
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