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

Parameswaran, Ahilan; Heitner, Shmuel; Thosar, Deepali; Fowler, Adam; Marks, Susan; O’Leary, Fenton

doi:10.1111/jpc.13932

Cited by 3 publications

(7 citation statements)

References 18 publications

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“…It has also been suggested that the scores that are currently available effectively predict the occurrence of significant injuries 18 . In contrast, data on paediatric patients have shown some conflicting results 12,13,15,19–21 . In our study, 4.1% of the cases presented to the emergency department 24 h after sustaining a minor head trauma, which was similar to other studies 13 …”

Section: Discussionsupporting

confidence: 84%

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

Pava¹,

Milani

Zuccotti

et al. 2022

Acta Paediatrica

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Aim: Validated clinical decision rules on neuroimaging are not available for children who are evaluated more than 24 h after a minor head trauma. We compared clinically important traumatic brain injuries in children who presented with a minor head trauma within or after 24 h. Methods:This was a retrospective analysis of patients aged 0-17 years, who were evaluated for minor head traumas by five paediatric emergency departments in Northern Italy between January 2019 and June 2020. Children with clinically important traumatic brain injuries were divided into those who had presented within and after 24 h. Results:The study comprised 5981 children (59.9% boys), with a median age of 2 years, including 243 (4.1%) who had presented more than 24 h after their minor head trauma. Neuroimaging was performed on 448 (7.5%) patients and the time of presentation had no impact on the rates of clinically important traumatic brain injuries.Multiple logistic regression did not show any association between clinically important traumatic brain injuries and late presentation. Conclusion:Delayed presentation to a paediatric emergency department after a minor head trauma did not alter the risk of clinically important traumatic brain injuries and the same neuroimaging rules could apply.

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Section: Discussionsupporting

confidence: 84%

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

Pava¹,

Milani

Zuccotti

et al. 2022

Acta Paediatrica

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“…Previously, Parameswaran et al 17 demonstrated that well infants presenting more than 24 hours after a head injury with a scalp hematoma are at negligible risk of injuries requiring an acute intervention. These findings were consistent with another study in which the authors indicated that no patients with delayed presentation, who were normal on neurological examination, required neurosurgical intervention or experienced a neurological worsening despite the fact that more than half of the patients revealed a TBI of some kind, and thus, they concluded that further radiographic investigation did not alter neurosurgical management in these patients 2 .…”

Section: Discussionmentioning

confidence: 99%

Children With a Soft Scalp Hematoma Presenting to the Emergency Department More Than 24 Hours After a Head Injury

Ferro¹,

Boccuzzi²,

Colafati

et al. 2022

Pediatr Emer Care

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ObjectivesThe soft scalp hematoma is one of the clinical markers used as a predictor for the presence of intracranial injury in children with a head trauma. We evaluated the significance of time presentation in the management of these patients.MethodsWe conducted a retrospective study of children and adolescents aged 0 to <18 years by comparing the clinical, radiological, and epidemiological features in those presenting within 24 hours with those presenting greater than 24 hours after a head injury.ResultsWe identified 188 and 98 patients with early presentation and late presentation, respectively. The percentage of children aged 0 to <6 months was lower in those with late presentation (6.12%) than those with early presentation (20.21%) with a significant difference (P < .001). Likewise, the percentage of children aged ≥24 months was lower in children with late presentation (7.14%) than those with early presentation (34.04%) with a significant difference (P < .001). The severe mechanism rate was more elevated in early presentation (38.83%) with a significant difference (−14.34%; 95% confidence interval [CI], −25.34% to −3.34%; P = .015). The symptom rate resulted higher in early presentation (14.36%) with a significant difference (−11.30%; 95% CI, −17.36% to 5.22%; P = .003). The parietal scalp hematoma occurred mostly in children with late presentation (85.71%) with a significant difference (19.76%; 95% CI, 10.07% to 29.45%; P < .001). The occipital scalp hematoma rate was higher in early presentation with a significant difference (−17.50%; 95% CI, −22.99% to −12.12%; P < .001). There was no significant difference in the prevalence of different types of intracranial injury, and the only 5 patients needing a neurosurgical intervention were exclusively children with an early presentation.ConclusionAlthough children with soft scalp hematoma presenting to the emergency department greater than 24 hours after a head injury may have pathological findings on computed tomography, all of them had a good short- and long-term outcomes, and no neurological deterioration aroused the medical attention on follow-up. For this subset of patients that does not experience red flags (neurological symptoms, focal signs on examination, or severe injury mechanism), a wait-and-see approach might be more appropriate rather than neuroimaging.

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Section: Discussionmentioning

confidence: 99%

“…Parameswaren, et al reported that 92% children presenting solely for scalp swelling to the emergency department more than 24 h after a head injury were found to have skull fractures. 7 Further, 42% had intracranial haemorrhages but none required intervention. 12,13 Since many of our accidental subjects did not have skeletal surveys, it is possible that a few had occult fractures.…”

Section: Ta B L E 1 Symptoms Leading To Evaluation Of Accidentally Injured Children Who Were Brought To Care Acutely or After Delaysmentioning

confidence: 96%

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

et al. 2020

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Skull fractures in children are commonly the result of accidental injury. However, providers must be careful to identify skull fractures caused by child abuse. [1][2][3] Delays in seeking medical care after an injury are associated with child abuse. 4,5 When considering whether delays in care are inappropriate, the severity of the child's medical condition must be considered. 5 When infants and toddlers sustain skull fractures due to minor falls, it is common for the children to have no or minimal concussive symptoms and to appear quite normal after a brief cry. 6 The authors' clinical experience is that these children often appear well and uninjured after their trauma. Caretakers

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

Cited by 3 publications

References 18 publications

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

Children With a Soft Scalp Hematoma Presenting to the Emergency Department More Than 24 Hours After a Head Injury

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

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