Thursday, August 29, 2013
Evaluating head trauma in children

By Dr. Anthony Policastro
I learned to evaluate head trauma in children during my pediatric residency. At that time, there was little you could do to identify a serious problem in the conscious patient. If the patient had an injury and was still unconscious, you knew it was serious. If that was not the case, then it was more difficult. Skull x-rays were of no value. All they could show was a fracture in the bones. However, even with a fractured skull, the only injury might be to the bone. The brain might be fine. The result was that we observed a lot of children in the hospital overnight. Even the ones that we sent home had to be watched carefully. I would tell the parents to put the child to bed. Then I would have them wake the child when the parents went to bed and once more in the middle of the night. If the child did not act normally, he/she needed to be seen. The good is that I never had a child that I sent home come back. They all did well. I also had all the children I observed overnight do well. The problem was that I was just lucky. We did not have a good test for head trauma patients. Then CT scans arrived. We were able to tell if there was bleeding into the head. It gave us a much higher level of reassurance that everything was all right. At first we did not do a lot of CT scans. We did them if we found something wrong on a neurologic exam. Then we started to do them a little more liberally. Now they are almost standard for head trauma patients. I have already mentioned the main problem that this creates. The radiation from CT scans slightly increases the risk of cancer later in life. A recent study points out another potential issue. I have often indicated that whenever you do a test, there are bound to be findings that have nothing to do with the original reason for the test. That is true with brain CT scans. In the study about 44,000 of children had brain CT scans because of head trauma. Six hundred and fifty four of them had findings that were not related to the head trauma. Some of them had serious problems. There were 22 of them. That means that about 1 out of every 200 CT scans done for head trauma showed a serious unexpected finding. Eleven of those children had a brain tumor. The other 11 had findings that also required medical care. This small group of children happened to have their head trauma at the right time. An additional 173 children had findings that required more testing. Some of these would turn out to be significant. Most would not. The result was that children would have to undergo more tests for something that would not have been a problem in the first place. They would have to have blood tests. Some of them would need brain MRI's and would have to be sedated for that procedure. Those other tests had their own set of complications to deal with. A third group of children had what were considered "benign" findings. There were 459 of these children. Of all the children with abnormal CT scans, this was the largest group. It accounted for 70% of the total. This means that the parents were told that there was something wrong with their child's brain on the CT scan. However, it was "benign" so they did not need to worry about it. I have had to tell parents about a lot of benign findings over the years. It has been my experience that what is benign to the physician is not necessarily that way to the parent. We can reassure them all we want. However, if we tell a parent that there is something wrong with their child's brain, reassurance is not likely to go a long way. When I was a resident, we might have missed the 22 patients with significant findings. However, if we did the right kind of neurologic evaluation for the head injury, there would likely be other symptoms present. What we would not have done is tell a group of parents that their child has something wrong with their brain. This becomes another instance of be careful what you ask for.

NHS welcomes Dr. Maharjan Nanticoke Health Services welcomes Raju Maharjan, MD to the Nanticoke Physician Network. Dr. Maharjan joins Nanticoke Health Services as a neurologist and is accepting new patients at 701 Middleford Rd., Ste. 201, Seaford.

Dr. Maharjan graduated with his medical diploma from Tribhuvan University in Kathmandu, Nepal in 2003. He completed his neurology residency at Penn State Hershey Medical Center and his clinical neurophysiology fellowship at West Virginia University. He worked as a physician in Nepal before coming to the U.S. In addition to English, Dr. Maharjan is fluent in Nepali and Hindi. To schedule an appointment, call 629-5193.

Parkinson support group The Nanticoke Parkinson Education and Support Group will hold its regularly scheduled meeting on Monday, Sept. 16 from 10 to 11:30 a.m., at the Nanticoke Senior Center, 1001 W. Locust St., Seaford. There will be a presentation by an elder care lawyer. The public is invited to attend. Contact Dennis Leebel at 644-3465 for more information.

Dr. Gorgui named associate Nanticoke Health Services announces that Khalil F. Gorgui, MD, medical director of the Nanticoke Wound Care and Hyperbaric Center, has been named an associate of the American Professional Wound Care Association (APWCA). Dr. Gorgui, an internal medicine physician who specializes in hyperbaric and wound management, brings with him broad experience in wound care, hyperbaric oxygen therapy, and internal medicine. He is board certified in internal medicine and has been a senior member of the medical staff at Nanticoke Memorial Hospital since 1995.

Behavioral Health Consultants sought A recruitment effort is underway to fill 30 positions for behavioral health consultants (BHCs) in middle schools statewide. The Department of Services for Children, Youth and Their Families (DSCYF) through its Division of Prevention and Behavioral Health Services (PBHS), has issued a Request for Proposal (RFP) to fill these positions in response to budget initiatives to expand access to mental health services for children. While many Delaware elementary schools have family crisis therapists and high schools have Wellness Centers where children can access help, middle schools have lacked similar supports. BHCs are highly trained and licensed mental health professionals. As part of the RFP, PBHS is also looking for a contract manager to oversee the program along with three county coordinators. Applications are due by Sept. 12. The RFP and application instructions can be found on the DSCYF website at, or the state bid website at under the title of Behavioral Health Services. Questions should be directed to H. Ryan Bolles, DSCYF procurement administrator, at or 302-633-2701.

Bike to the Bay for MS Bike to the Bay presented by NRG Indian River Generating Station is Sept. 21-22. Celebrating its 30th anniversary, Bike to the Bay is the largest and longest running bike ride in Delaware. The goal is to raise MS awareness and $1 million to support national multiple sclerosis research as well as programs and services needed by more than 1,550 Delawareans with MS. Bike to the Bay attracts more than 1,800 bicyclists. The ride covers much of Kent and Sussex counties, with a choice of six route options, and finishes at the Towers at Delaware Seashore State Park, just south of Dewey Beach. For more details and to register, visit or call 302-655-5610.

2013 Aids Walk Delaware Registration is open for the 2013 AIDS Walk Delaware which will be held on Saturday, Sept. 28, in Rehoboth and Wilmington. To register a group or an individual, visit Sign up today and begin collecting pledges for people infected and affected by HIV disease throughout the state. For more information, contact the Delaware HIV Consortium at 302-654-5471 or