Occult intracranial injury in infants

Study objectives: The objectives of this study were as follows (1) to deter mine whether clinical symptoms and signs of brain injury are sensitive indi cators of intracranial injury (ICI) in infants admitted with head trauma, ( 2) to describe the clinical characteristics of infants who have ICI in the absence of symptoms and signs of brain injury, and (3) to determine the cli nical significance of those ICIs diagnosed in asymptomatic infants. Methods: We conducted a retrospective analysis of all infants younger than 2 years of age admitted to a tertiary care pediatric hospital with acute IC I during a 6 1/2-year period. Infants were considered symptomatic if they h ad loss of consciousness, history of behavior change, seizures, vomiting, b ulging fontanel, retinal hemorrhages, abnormal neurologic examination, depr essed mental status, or irritability. All others were considered to have oc cult ICI. Results: Of 101 infants studied, 19(19%; 95% confidence interval [CI] 12%, 28%) had occult ICI. Fourteen of 52 (27%) infants younger than 6 months of age had occult ICI, compared with 5 of 34 (15%) infants 6 months to 1 year, and none of 15 (0%) infants older than 1 year. Eighteen (95%) infants with occult ICI had scalp contusion or hematoma, and 18(95%) had skull fracture . Nine (47%) infants with occult ICI received therapy for the ICI. Na infan ts with occult ICI (0%) (95% CI 0, 14%) required surgery or medical managem ent for increased intracranial pressure. Only 2 subject(5%) with occult ICI had any late symptoms or complications: a brief, self-limited convulsion. Conclusion: We found that 19 of 101 ICIs in infants admitted with head trau ma were clinically occult. All 19 occult ICIs occurred in infants younger t han 12 months of age, and 28 of 19 had skull fractures. None experienced se rious neurologic deterioration or required surgical intervention. Physician s cannot depend an the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.