Clinical Predictors of Intracranial Injuries in Infants with Minor Head Trauma.

OBJECTIVE: Minor head trauma is common in children. Although most cases are nonsignificant, minor head trauma can lead to preventable intracranial injuries. The aim of this study was to identify clinical predictors of intracranial injuries in infants with minor head trauma.

METHODS: Between 2006 and 2013, we retrospectively enrolled infants <11 months old with minor head trauma. Data recorded included age, sex, cause of trauma, fall height, vomiting, bad temper, size and location of scalp hematoma, fracture, and intracranial injuries on computed tomography.

RESULTS: Of 549 enrolled infants, 15 (3%) sustained traumatic intracranial injuries: epidural hematoma in 7, subarachnoid hemorrhage in 4, subdural hematoma in 3, and cerebral contusion in 1. Intracranial injuries were found in 8 of 98 infants who had fallen from a >60 cm height, 1 in 197 with fall height >30 cm, and none in 44 with fall height ≤30 cm (P = 0.0001); 1 of 2 with scalp hematomas >6 cm, 10 of 35 with hematomas >3 cm, and 2 of 121 with hematomas ≤3 cm (P = 0.0001); and 9 of 28 with temporal hematoma, 2 of 15 with parietal hematoma, 2 of 22 with occipital hematoma, and none of 98 with frontal hematoma (P = 0.0001). Logistic regression analysis showed that scalp hematoma was related to intracranial injuries (hazard ratio = 21.127, P = 0.0001), whereas age, sex, fall, vomiting, and bad temper were not.

CONCLUSIONS: Fall height and size and location of scalp hematoma were associated with intracranial injuries. These factors should be considered when making decisions on radiologic examinations of infants with minor head trauma.