Investigators from Bambino Gesu Children’s Hospital, Rome, Italy, conducted a retrospective study to describe the clinical characteristics, radiologic findings, and management in children with soft scalp hematomas from nonintentional blunt head trauma who present to an emergency department (ED) >24 hours after injury (late presentation) and compare these patients to children with an early presentation (evaluated ≤24 hours after injury). Study participants were patients <18 years old presenting to a single level III trauma center at a children’s hospital with soft scalp hematoma following head trauma between 2014 and 2018. Only children with an initial Glasgow Coma Scale >13 at the ED were included. The medical records of eligible patients were reviewed and data on age (categorized as <6 months, ≥6 to <24 months, or ≥24 months), mechanism of injury, location of scalp hematoma, head CT findings, and initial management (hospitalization for ≥2 nights, intubation, neurosurgery) abstracted. The mechanism of injury was classified as severe using standardized criteria. A diagnosis of any traumatic brain injury (TBI) was made if there were any findings on CT; a significant TBI was defined as CT finding of intracranial hematoma or hemorrhage, brain contusion, midline shift or depressed skull fracture. Differences between children with early or late presentation were compared with chi square or t-tests.
Data were analyzed on 286 patients with soft scalp hematomas following head trauma, including 188 with early and 98 with late presentation. Children <6 months old and those ≥24 months were significantly more likely to have early presentation, while those ≥6 to <24 months were significantly more likely to be in the late presentation group. Patients presenting early were significantly more likely to have a severe mechanism of injury than those with late (38.3% vs 24.5%; P = 0.015), have an occipital hematoma (17.5% vs 0; P <0.001), and less likely to have a parietal hematoma (66.06% vs 85.7%; P <0.001). Head CT was performed on 159 (84.6%) children with early and 51 (52.0%) of those with late presentation (P <0.001). Among those with early presentation, 59.1% had any TBI, compared to 66.7% of those with late presentation. Rates of a significant TBI were 27.5% and 25.5%, respectively; neither of these differences were significant. There also was no difference in rates of hospitalization for ≥2 nights between groups (13.7% and 5.9%, respectively, for children with early or late presentation). No children with late presentation required neurosurgery or other interventions; 5 patients in the early presentation group underwent neurosurgery.
The authors conclude that children with late presentation with soft scalp hematoma frequently had findings of TBI on CT, but none required neurosurgery or other interventions.
Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary...