Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 1: What is the significance of a 'boggy' (soft) scalp haematoma in head-injured children?

A short-cut review was carried out to establish whether the presence of a soft (boggy) scalp haematoma predicts the presence of intracranial injury in head-injured children. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1. The clinical bottom line is that the presence of a soft (boggy) scalp haematoma appears to predict positive findings on CT imaging. In the one study that directly addressed the three-part question, it was concluded to warrant CT imaging. Since that time, however, concern regarding the risks associated with irradiation of children may challenge a strategy of imaging otherwise asymptomatic children with no other indication for CT imaging.