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Updated: Jan 28, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Traumatic brain injury in young children with isolated scalp haematoma
Silvia Bressan1, Amit Kochar2, Ed Oakley3,4,5
1Department of Women's and Children's Health, University of Padova, Padova, Italy.
Insights
In young children with scalp hematomas (SH) as the only head trauma sign, the Pediatric Emergency Care Applied Research Network (PECARN) rule showed a 0% risk of clinically important traumatic brain injury (ciTBI). The Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) rule indicated a 20% ciTBI risk.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Clinical Prediction Rules
Background:
- Managing young children with isolated scalp hematomas (SH) after head trauma presents challenges despite existing clinical prediction rules.
- Accurate risk assessment for intracranial injury is crucial for guiding diagnostic imaging decisions in pediatric head trauma cases.
Purpose of the Study:
- To determine the risk of clinically important traumatic brain injury (ciTBI) in young children where isolated scalp hematomas (SH) are the sole indicator of head trauma.
- To evaluate the utility of the Pediatric Emergency Care Applied Research Network (PECARN) and Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) rules in defining isolated SH for risk stratification.
Main Methods:
- Secondary analysis of a multicenter prospective observational study involving 5237 children under 2 years old with head trauma.
- Utilized definitions of isolated SH from PECARN (any non-frontal hematoma) and CHALICE (>5 cm hematoma) in children under 1 and under 2 years.
- Defined ciTBI as death, neurosurgery, prolonged intubation (>24 hours), or positive CT scan associated with hospitalization ≥2 nights for traumatic brain injury.
Main Results:
- In children under 1 year with isolated SH per PECARN criteria, the risk of ciTBI was 0.0% (0/109).
- In children under 1 year with isolated SH per CHALICE criteria, the risk of ciTBI was 20.0% (7/35), with one requiring neurosurgery.
- Similar results were observed for children under 2 years and when using rule-specific outcomes.
Conclusions:
- The PECARN and CHALICE rules, when applied to isolated scalp hematomas in young children, help clinicians assess the risk of ciTBI.
- These risk assessments are vital for guiding decisions regarding the necessity of computed tomography (CT) scans in pediatric head trauma evaluations.
- Differentiating risk based on rule definitions aids in appropriate clinical management and resource utilization.
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.
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