Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital.
Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh.
Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal