MILD CLOSED HEAD INJURY

Objective: To review the literature on mild closed head injury with a focus on definitions and pathophysiological mechanisms. Methods: A systematic review of the medical and psychological literature was completed and the results were analysed. Results: Mild closed head injury in children should be assessed from a functional perspective. An agreed upon definition is an acute blow to the head or from acceleration/deceleration injury that correlates with a Glasgow Coma Scale of 13–15 and associated with temporary loss of consciousness, vomiting, lethargy and headache (including seizures occurring immediately after the impact). Pathophysiological markers of head injury include S-100B (an acidic calcium-binding protein) and neuron specific enolase (NSE) which correlate relatively well with severe brain injury. There is a recognized association with the apolipoprotein a (APO a ) 4 allele genotype. A new simple binary classification of concussion has eliminated the need for injury grading scales. “Simple” concussion gradually resolves over a 7–10 day period. “Complex” concussion is characterized by persistent symptoms, prolonged loss of consciousness (