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Paediatric head injury — RACP Paediatrics MCQ

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ModerateEmergency paediatricsPaediatric head injuryRACP Paediatrics

A 5-year-old falls from playground equipment. Two hours later he has repeated vomiting, severe headache and a fluctuating GCS of 14; there is a large parietal scalp haematoma. What is the most appropriate investigation?

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Correct answer: D — Urgent CT brain after senior assessment

Repeated vomiting, severe headache, fluctuating GCS and sizeable scalp haematoma are concerning features after head injury, so urgent CT is appropriate after senior assessment. Skull radiograph cannot exclude intracranial injury. The pearl is that decision rules support imaging when multiple risk features cluster, even if the child is not comatose.

Reference: RCH Clinical Practice Guidelines: Head injury; Australian paediatric emergency guidance