Pediatrics World Conference 2026

Abstract

Introduction:

Haematomas can indicate serious head injuries in children. The paediatric head injury NICE guideline states that for infants under one year of age, any bruise, swelling, or laceration greater than 5 cm is an indication for a CT scan within one hour. However, in my recent experience, I report three cases of children with minor head injuries from different incidents involving boggy swelling haematomas less than 2 cm. In these cases, I indicated a CT head scan based on my experience, which demonstrated 100% sensitivity for positive findings, necessitating urgent referrals to neurosurgery in one instance.

Methods:

Case 1: A few-week-old infant was accidentally dropped by their brother, resulting in a minor head injury. The child did not exhibit focal neurological signs and appeared normal, but there was a small haematoma of less than 1 cm over the temporal region. A junior doctor in the emergency department liaised with paediatric registrars, who suggested admission without imaging; however, a CT scan was performed after a paediatric Emergency Medicine consultant recommended it.

Case 2: A 2-year-old boy fell from a chair onto a concrete floor, sustaining a small boggy swelling in the occipitoparietal region. He was examined by a junior doctor who found no focal neurological signs and deemed the child to be normal; they were ready to discharge the patient. However, following consultation with the paediatric Emergency Medicine consultant, a CT scan was conducted.

Case 3: A 4-year-old girl was brought in by her mother five days after falling from an armchair while abroad. The child appeared to be completely fine, without neurological signs and was considered normal. However, there was boggy swelling in the temporal region, leading to a CT scan.

Conclusion:

All cases presented with positive findings on their scans:

- Case 1: The CT reported a left-sided acute subdural haematoma along with a chronic subdural haematoma and a small extradural haematoma with a midline shift, necessitating a time-critical transfer to a paediatric neurosurgical department.

- Case 2: There was a small skull fracture with a right temporal subdural haematoma, which required a paediatric neurosurgical referral and admission for neuro-observation for 48 hours.

- Case 3: The findings included a small parietal bone fracture with small intraparenchymal haemorrhage, necessitating a referral and local admission for 48 hours of neurological observation.

Discussion:

Reflecting on these cases, we urge a meticulous reevaluation of the head injury guidelines for children or a revision that includes boggy swelling as an indication for a CT head scan within one hour of presentation in the emergency department.