Abstract 466 Emergency Medicine I Platform, Monday, 5/3

BACKGROUND: Infants with intracranial injury (ICI) may have no symptoms or signs of brain injury. In many cases, scalp hematoma, indicating underlying skull fracture (SF), is the only abnormal physical finding. OBJECTIVE: To determine the significance of size and location of scalp hematomas for predicting SF and ICI in asymptomatic head-injured infants. METHODS: We prospectively collected data on historical features, physical findings, and results of imaging studies (skull radiographs and/or head CT) for all head-injured children ≤ 2 years of age presenting to a pediatric emergency department over a 1 year period. Asymptomatic subjects had none of the following symptoms or signs: loss of consciousness, history of behavior change, persistent emesis, seizures, depressed mental status, irritability, focal neurologic findings, bulging fontanel, or abnormal vital signs. Treating clinicians reported the location and size of scalp hematomas according to pre-defined criteria. RESULTS: Of 608 infants with head trauma, 431 (71%) were asymptomatic. 181/431 (42%) asymptomatic subjects had imaging, of which 51 (28%) had SF. The table shows results for those asymptomatic subjects who had imaging. As shown, hematoma size correlated directly with risk of SF. Parietal and temporal hematomas conferred a high risk for SF. In contrast, frontal hematomas were rarely associated with SF. 14 subjects were diagnosed with ICI. Of 84 subjects who had head CT, 1/23 (4%) subjects with no hematoma had ICI, as compared with 8/22 (36%) subjects with large hematoma (p=.03), and 12/38 (32%) subjects with parietal hematoma (p=.04). CONCLUSIONS: In asymptomatic head-injured infants, large scalp hematomas, and hematomas of the temporoparietal scalp, indicate a high risk of SF and associated ICI. Radiographic imaging of asymptomatic head-injured infants should be directed primarily at patients with these high risk findings.

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