The Importance of Scalp Hematoma In Predicting Intracranial Injury in Elderly Patients with Minor Blunt Head Trauma

Abstract

Introduction: Several widely employed criteria have been developed to determine indications for brain computed tomography (CT) in adult patients, such as the New Orleans Criteria and the Canadian CT Head Rule. However, a subgroup analysis of these criteria with appropriate sensitivity has not been performed in elderly population, and their reliability for this population is controversial. Therefore, there is a need for new studies that can predict intracranial injury (ICI) in elderly population. The purpose of this study was to evaluate the role of the site of trauma and size of scalp hematoma in determining ICI in the population aged over 65. Methods: This prospective, observational study was conducted over approximately 3 years in the emergency department of a tertiary training and research hospital. Consecutive patients aged over 65 with minor head trauma were included in the study. In these patients, the area of head trauma, presence of scalp hematoma, and whether the size of the hematoma differed between patients with ICI and patients without ICI were calculated statistically. ROC curves were drawn to test the success of hematoma in differentiating patients with and without ICI. The two proportions t-test was used in the comparison of areas with head trauma. Results: Of the 405 patients included in the study, 27 had ICI. The mean scalp hematoma diameter among the patients with ICI was 68±25 mm, compared to 16±21 mm in patients without ICI, and the difference was significant (p