Children who have suffered a traumatic loss of consciousness or have a transiently altered neurological examination are generally admitted overnight to a hospital or observation unit (see Table 2). Extremely rarely, a child with a 'minor' closed head injury and a benign admission CT scan will deteriorate neurologically. This may be due to cerebral edema, often exacerbated by hyponatremia and/or post-traumatic seizures, or expansion of a tiny intracranial hematoma that may not have been noted on an initial CT (often because of artifact from the adjacent skull). Any child who suffers deterioration in GCS or neurological examination should immediately undergo repeat neurosurgical evaluation and CT scan.
Patients with a GCS of 15 and a normal neurological examination may be discharged 18 to 24 hours after injury if reliable caregivers agree to continue home observation for 48 hours. No further imaging is necessary. Parents should
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