The predictive and diagnostic value of clinical signs of intracranial injury (ICI) in head-injured infants was studied at Children’s Hospital, Harvard Medical School, Boston, MA. Of 608 infants presenting at the emergency department with head injury, 30 (5%) had ICI; 13% 0-2 months of age had ICI, compared to 6% of infants 3 to 11 months, and 2% of infants 12 months or older. Only 52% of infants with ICI had one or more of the following clinical signs of brain injury: loss of consciousness, seizures, vomiting, irritability, bulging fontanel, focal neurologic signs, or signs of increased intracranial pressure. Of 14 asymptomatic infants with ICI, 93% had scalp hematoma. Scalp hematoma was strongly associated with ICI in infants having CT scans. 
COMMENT. Clinical symptoms and signs of brain injury are of limited value in the diagnosis of intracranial injury in infants. Radiographic imaging is important in the work-up of infants with head injury even when asymptomatic, especially in those with scalp hematoma and in infants younger than 3 months of age. The younger the infant, the greater the risk of ICI. Asymptomatic infants older than 3 months of age who present with a history of head injury and who have no scalp hematoma are not likely to have sustained intracranial injury.