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Traumatic brain injury in young children with isolated scalp haematoma
  1. Silvia Bressan1,
  2. Amit Kochar2,
  3. Ed Oakley3,4,5,
  4. Meredith Borland6,7,
  5. Natalie Phillips8,
  6. Sarah Dalton9,
  7. Mark D Lyttle10,11,
  8. Stephen Hearps5,
  9. John Alexander Cheek4,
  10. Jeremy Furyk12,
  11. Jocelyn Neutze13,
  12. Stuart Dalziel14,
  13. Franz E Babl3,4,5
  14. on behalf of the Paediatric Research in Emergency Department International Collaborative (PREDICT) group
    1. 1 Department of Women’s and Children’s Health, University of Padova, Padova, Italy
    2. 2 Pediatric Emergency, Women’s and Children’s Hospital Adelaide Women’s and Babies Division, North Adelaide, South Australia, Australia
    3. 3 Departmentof Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
    4. 4 Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
    5. 5 Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
    6. 6 Emergency Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
    7. 7 Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
    8. 8 Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
    9. 9 Emergency Department, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
    10. 10 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
    11. 11 Academic Department of Emergency Care, University of the West of England, Bristol, Avon, UK
    12. 12 Emergency Department, University Hospital Geelong, Victoria, Australia
    13. 13 Emergency Medicine, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand
    14. 14 Emergency Department, Starship Children’s Health, Auckland, New Zealand
    1. Correspondence to Prof Franz E Babl, Emergency Department, Royal Children’s Hospital, Parkville VIC 3052, Australia; franz.babl{at}


    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.

    • traumatic brain injury
    • children
    • scalp haematoma
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    • Contributors SB had the initial idea and contributed to the design of the study, drafted the initial manuscript and revised the article. She takes responsibility for the paper as a whole. AK made substantial contributions to the interpretation and discussion of findings and the drafting of the manuscript and critically revised the manuscript for important intellectual content. EO, MB, NP, SaD, MDL, JAC, JF, JN and StD made substantial contributions to the interpretation and discussion of findings and critically revised the manuscript for important intellectual content. SH contributed to the design of the study, carried out the initial analyses, drafted the tables and critically revised the manuscript for important intellectual content. FEB had the initial study idea, contributed to the design of the study and critically revised the manuscript for important intellectual content.

    • Funding The study was funded by grants from the National Health and Medical Research Council (project grant GNT1046727, Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560), Canberra, Australia; the Murdoch Children’s Research Institute, Melbourne, Australia; the Emergency Medicine Foundation (EMPJ-11162), Brisbane, Australia; Perpetual Philanthropic Services (2012/1140), Australia; Auckland Medical Research Foundation (No. 3112011) and the A + Trust (Auckland District Health Board), Auckland, New Zealand; WA Health Targeted Research Funds 2013, Perth, Australia; the Townsville Hospital and Health Service Private Practice Research and Education Trust Fund, Townsville, Australia; and supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. FEB’s time was part funded by a grant from the Royal Children’s Hospital Foundation and the Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia, and an NHMRC Practitioner Fellowship, Canberra, Australia. StD’s time was part funded by the Health Research Council of New Zealand (HRC13/556).

    • Competing interests None declared.

    • Ethics approval The study was approved by the institutional ethics committees at each site.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Dr Yuri Gilhotra, Emergency Department, Queensland Children’s Hospital, Brisbane, Queensland, Australia; Professor Susan Donath, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.

    • Patient consent for publication Not required.

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