Children presenting in delayed fashion after minor head trauma with scalp swelling: do they require further workup?

Abstract

Pediatric patients ≤24 months of age presenting to the ER in delayed fashion with scalp swelling after minor head trauma-who were otherwise nonfocal on examination-did not require surgical intervention and did not experience any neurologic decline. Further radiographic investigation did not alter neurosurgical management in these patients; however, it should be noted that workup for child abuse and social care may have been influenced by CT findings, suggesting the need for the future development of a clinical decision-making tool to help safely avoid CT imaging in this setting.

Trial of life: Well infants presenting more than 24 h after head injury with a scalp haematoma: A 10‐year review

“…All of Sellin et al . 's patients had a CT head, and they describe isolated linear/non‐displaced skull fractures in 33 of 78 (42%) of patients, linear/non‐displaced skull fractures with associated extra‐axial haemorrhage (epidural or subdural hematoma) in 32 of 78 (41%) and a normal CT head in 4 of 78 (5.1%) . These results are almost identical to our results, and the higher rate of skull fracture in this and our study is probably related to the population group, that is, patients presenting with a scalp haematoma more than 24 h after injury may be more likely to have an underlying skull fracture.…”

“…of 76 patients over 2 years, reviewing children younger than 24 months old who presented more than 24 h after injury with scalp swelling after minor head trauma. No patients in that study required neurosurgical intervention or experienced a neurological decline or alteration in neurosurgical management from CT imaging …”

“…Those presenting after 24 h who were positive for clinically significant intracranial injury represented just 0.05% of all patients who underwent imaging . The limited available evidence suggests that the risk of neurological decline and neurosurgical intervention in head‐injured children presenting after 24 h is very low …”

Delays in care seeking for young children with accidental skull fractures are common

“…Delays in seeking medical care for infants and toddlers with skull fractures and STS have been reported, varying from 6.7% to 17.4% of children. 7,8 However, the duration and nature of the delays remain undocumented.…”

“…Delay in care for children with simple and complex skull fractures, listed as n (%) Sellin, et al found that 41% of children presenting to the emergency department for isolated scalp swelling more than 24 h after injury had an isolated skull fracture and 42% had both a skull fracture and intracranial haemorrhage, but none required intervention 8. Both studies confirm our results that delayed presentations are common for well appearing children with skull fractures presenting to the emergency department for isolated scalp swelling.…”