Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?

Zaman, Samina; Logan, Patty; Landes, Caren; Harave, Srikrishna

doi:10.1016/j.crad.2016.12.012

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…We noted that the thickness of soft swelling scalp was significantly higher in children with a late presentation than children with an early presentation of the soft scalp hematoma. In previous studies, larger hematomas conferred greater odds of TBI, 5,8,19 and for this reason, as recommended by the most important clinical decision rules, 9,10,12 the hematoma size is a criterion to require CT. Nevertheless, we believe that an increasing hematoma size in late presentation is not always a negative factor, but it might constitute a protective factor in children with skull fractures.…”

Section: Discussionmentioning

confidence: 94%

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: 94%

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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“…Studies by Zaman et al have shown that in small children, already in superficial injuries of soft tissues of the head, skull bones can be injured, as well as post-traumatic hemorrhage can occur. In addition, the study suggests that computed tomography of the head should also be performed routinely in children with soft tissue injuries < 5 cm, and in children aged 1 to 3 years if the diagnosis of cranial fracture would change the rescue procedure to the fullest extent within the further management [19].…”

Section: Discussionmentioning

confidence: 99%

To assess the fluctuations in the incidence of head injuries in paediatric patients in the medical emergency teams material

Yakubtsevich

Małysz

Smereka

et al. 2018

Disaster Emerg Med J

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inTroducTion: Head injuries in children pose a serious challenge both in terms of the management and diagnostics. Due to technological progress and thus the development of motorization, despite the decreasing overall injury rate, the incidence of high-energy injuries increases. The aim of the study was to assess the frequency of intervention of emergency medical teams to paediatric patients due to head injuries. MeThods: The study was a retrospective study. The material consisted of medical interventions of medical rescue teams from the regions of Piaseczno and Pruszków from the period 11.2016-10.2017. 422 medical emergency records were analyzed. resulTs: Median age of study group was 7.7 years (IQR; 3-12)-females 7.6 years (IQR; 2-13) and males 7.9 years (IQR; 4-12). The injuries occurred most frequently in March (n = 43; 11.8%), and least frequently in February (n = 22; 5.2%). The above relation occurred regardless of gender. Injuries occur most frequently in spring (n = 132; 31.3%), and least frequently in summer (n=88; 20.8%; Tab. 1). In the afternoon an increase in the incidence of injuries was observed. Differences in the incidence of injuries in the group of males and females depending on the time of day were not significantly statistical (p = 0.206). Superficial head injury was the most common injury (n = 122; 28.9%) followed by open head wounds in both males and females. conclusions: The most frequent head injuries were superficial head injuries followed by open head injuries. Injuries occurred more often on weekdays, less frequently at weekends. In the afternoon an increase in the incidence of injuries was observed. Injuries occur most frequently in spring and least frequently in summer on a monthly basis they occurred most frequently in March, and least frequently in February regardless of gender.

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“…A maxillofacial radiologist at KSMC requested a second CT scan after the patient arrived at the clinic, with the justification that, according to the literature, children as young as 3 years old can have a CT scan of the head if a head injury is suspected 21 . Because the patient was 9 years old and suffered from poor nutrition because of her limited mouth opening, the only thing that could be done at that stage was to perform another CT scan to rule out any problems due to the original trauma.…”

Section: Casementioning

confidence: 99%

Delayed diagnosis in the maxillofacial region: Two case reports

Zain-Alabdeen

Al‐Sadhan

Al-Suhaim

et al. 2017

Journal of Taibah University Medical Sciences

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While conventional CT scan has historically been used for maxillofacial bone imaging. The introduction of cone beam CT (CBCT) in the new millennium has revolutionized the use of CT for dental and maxillofacial diagnoses. This paper presents two clinical examples of delayed diagnoses associated with maxillofacial imaging, describes the reasons for the delays and offers potential preventive measures. The first case involves a delay in the diagnosis of non-Hodgkin's lymphoma in a 49-year-old female who was being treated for an odontogenic problem. In the second case, a 9-year-old female who presented with a limited ability to open her mouth was mistakenly diagnosed with muscles spasm. Subsequently, she was found to have an elongation of the right lateral pterygoid plate that interfered with her right mandibular body, which restricted the degree to which she could open her mouth. A thorough clinical examination and accurate radiographic interpretation combined with a complete medical history can minimize these types of diagnostic delays. If the dentist is unable to conclusively reach a diagnosis, the patient should be referred immediately to a specialist who can better manage the specific medical problem.

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Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?

Cited by 6 publications

References 11 publications

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

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

To assess the fluctuations in the incidence of head injuries in paediatric patients in the medical emergency teams material

Delayed diagnosis in the maxillofacial region: Two case reports

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