Approach to traumatic brain injury (pediatrics) Quiz: Ace Your Exams

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A 3-year-old boy is brought to the emergency department by his parent for evaluation of vomiting and lethargy. The boy’s parent found the patient lying on ground vomiting beside the outdoor play set in their backyard, where he had been playing with his older siblings. The patient has no significant past medical history and takes no medication. Temperature is 37°C (98.6°F), pulse is 55/min, respirations are 24/min and irregular, blood pressure is 112/45 mmHg, and oxygen saturation is 99% on room air. The patient appears lethargic. He is moving all extremities spontaneously and localizes to pain. He opens his eyes to verbal stimulation and utters nonsensical words. Which of the following additional clinical elements, if present, is most specifically associated with the severity of this patient’s presentation?

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History of recent ibuprofen use

Fall from four feet

Blurry vision

Frontal scalp hematoma

History of a recent concussion