{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T03:43:29Z","timestamp":1790221409248,"version":"4.1.0"},"reference-count":13,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,10,1]]},"abstract":"<jats:sec><jats:title>Objectives.<\/jats:title><jats:p>1) To determine whether clinical signs of brain injury are sensitive indicators of intracranial injury (ICI) in head-injured infants. 2) To determine whether radiographic imaging of otherwise asymptomatic infants with scalp hematoma is a useful means of detecting cases of ICI. 3) To determine whether head-injured infants without signs of brain injury or scalp hematoma may be safely managed without radiographic imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>We performed a 1-year prospective study of all infants younger than 2 years of age presenting to a pediatric emergency department with head trauma. Data were collected on historical features, physical findings, radiographic findings, and hospital course. Follow-up telephone calls were made 2 weeks after discharge to assess for any late deterioration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Of 608 study subjects, 30 (5%) had ICI; 12\/92 (13%) infants 0 to 2 months of age had ICI, compared with 13\/224 (6%) infants 3 to 11 months of age, and 5\/292 (2%) infants 12 months of age or older.<\/jats:p><jats:p>Only 16\/30 (52%) subjects with ICI had at least one of the following clinical symptoms or signs of brain injury: loss of consciousness, history of behavior change, seizures, emesis, depressed mental status, irritability, bulging fontanel, focal neurologic findings, or vital signs indicating increased intracranial pressure.<\/jats:p><jats:p>Of the 14 asymptomatic subjects with ICI, 13 (93%) had significant scalp hematoma. Among subjects who had head computed tomography, significant scalp hematoma had an odds ratio of 2.78 (95% confidence interval: 1.15,6.70) for association with ICI.<\/jats:p><jats:p>A total of 265 subjects (43%) were asymptomatic and had no significant scalp hematoma. None (95% confidence interval: 0,1.2%) required specific therapy or had any subsequent clinical deterioration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants older than 3 months of age who have no significant scalp hematoma may be safely managed without radiographic imaging.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.104.4.861","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"861-867","source":"Crossref","is-referenced-by-count":152,"title":["Clinical Indicators of Intracranial Injury in Head-injured Infants"],"prefix":"10.1542","volume":"104","author":[{"given":"David S.","family":"Greenes","sequence":"first","affiliation":[{"name":"1 From the Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara A.","family":"Schutzman","sequence":"additional","affiliation":[{"name":"1 From the Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, 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