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Arch Dis Child. 2019 Mar 4. pii: archdischild-2018-316066. doi: 10.1136/archdischild-2018-316066. [Epub ahead of print]

Traumatic brain injury in young children with isolated scalp haematoma.

Author information

1
Department of Women's and Children's Health, University of Padova, Padova, Italy.
2
Pediatric Emergency, Women's and Children's Hospital Adelaide Women's and Babies Division, North Adelaide, South Australia, Australia.
3
Departmentof Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
4
Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
5
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
6
Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.
7
Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia.
8
Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
9
Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
10
Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
11
Academic Department of Emergency Care, University of the West of England, Bristol, Avon, UK.
12
Emergency Department, University Hospital Geelong, Victoria, Australia.
13
Emergency Medicine, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand.
14
Emergency Department, Starship Children's Health, Auckland, New Zealand.

Abstract

OBJECTIVE:

Despite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.

DESIGN:

Planned secondary analysis of a multicentre prospective observational study.

SETTING:

Ten emergency departments in Australia and New Zealand.

PATIENTS:

Children <2 years with head trauma (n=5237).

INTERVENTIONS:

We used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.

MAIN OUTCOME MEASURES:

Clinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).

RESULTS:

In children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.

CONCLUSIONS:

In young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.

TRIAL REGISTRATION NUMBER:

ACTRN12614000463673.

KEYWORDS:

children; scalp haematoma; traumatic brain injury

Conflict of interest statement

Competing interests: None declared.

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