title: Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?
abstract: OBJECTIVE
  To determine whether it is justified to undertake a computed tomography (CT) examination of the head in children under 1 year of age who present with a bruise, swelling, or laceration of >5 cm following head injury in children presenting to a paediatric accident and emergency (A&E) department in the northwest of England. Further aims were to determine whether there was any justification for performing a CT head examination for children with soft-tissue injuries measuring <5 cm, or for children >1 year with evidence of soft-tissue injury, but without any other concerning feature.
  
  
  METHODS
  Children <3 years of age presenting with soft-tissue evidence of head injury between May 2011 and Oct 2014 and who subsequently underwent head CT were retrospectively identified from radiology requests. The CT images and clinical notes were used to identify those with skull fracture or intracranial haemorrhage and to determine whether the child was subsequently admitted or discharged from A&E.
  
  
  RESULTS
  Eighty-five CT head examinations met the criteria for inclusion. Of these, 45 examinations demonstrated skull fractures and four examinations identified intracranial haemorrhage. Thirty-eight requests included soft-tissue evidence of head injury as the sole reason indicated for CT head examination. Of these, 22 examinations demonstrated skull fractures and one examination identified intracranial haemorrhage.
  
  
  CONCLUSIONS
  Soft-tissue evidence of head injury as the sole reason for CT head examination appears to be justified in the present patient population. Furthermore, this study suggests that CT head examination should also be considered for children with soft-tissue injuries of <5 cm and for children aged between 1 and 3 years if identification of a skull fracture would alter the child's management.
authors.affiliation: Department of Radiology, Alder Hey Children's NHS Foundation Trust, 1 Eaton Road, Liverpool L12 2AP, UK. Electronic address: sherry_zaman@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Zaman
authors.affiliation: Department of Radiology, Alder Hey Children's NHS Foundation Trust, 1 Eaton Road, Liverpool L12 2AP, UK.
authors.forename: P H
authors.initials: PH
authors.lastname: Logan
authors.affiliation: Department of Radiology, Alder Hey Children's NHS Foundation Trust, 1 Eaton Road, Liverpool L12 2AP, UK.
authors.forename: C
authors.initials: C
authors.lastname: Landes
authors.affiliation: Department of Radiology, Alder Hey Children's NHS Foundation Trust, 1 Eaton Road, Liverpool L12 2AP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Harave
mesh_terms: D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications* / Q000000981:diagnostic imaging*; D017695:Soft Tissue Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods*