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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
Author(s) -
Parameswaran Ahilan,
Heitner Shmuel,
Thosar Deepali,
Fowler Adam,
Marks Susan,
O'Leary Fenton
Publication year - 2018
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13932
Subject(s) - medicine , scalp , skull fracture , head injury , emergency department , surgery , skull , population , retrospective cohort study , medical record , pediatrics , environmental health , psychiatry
Aim To review the investigation, patterns of injury and short‐term outcomes of infants younger than 12 months of age who presented more than 24 h after head injury with an isolated scalp haematoma. Methods A retrospective chart review of infants who presented with a head injury to the emergency department of a major paediatric hospital between 2006 and 2016. Patients were included if they presented more than 24 h after the injury, were clinically well and had a documented scalp haematoma. Charts were abstracted using a standardised instrument to yield patient characteristics, mechanism of injury, imaging performed, identified injuries and patient outcome. Results A total of 2433 records were reviewed, with 157 included in the study. The mean age was 7.5 months (standard deviation 2.6). Of the patients, 14 had a documented palpable skull fracture; 43 patients had a skull X‐ray reported as a fracture; 13 patients had cranial ultrasounds with 3 reported as having a fracture; 124 patients had computed tomography head imaging, with 112 demonstrating a fracture; and 52 patients had acute intracranial abnormalities. There were nine unplanned representations (5.7%). No patients required any neurosurgical intervention. Conclusions Infants presenting after 24 h with isolated scalp haematomas had good short‐term outcomes despite a high prevalence of underlying injury on imaging. Expectant management, rather than imaging, may be a valid approach in this patient population. However, some of these injuries may have been the result of inflicted injury, and all of these patients require a robust assessment regardless of the decision to use a computed tomography scan.