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. [1]

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.