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Clinical scenario
A 17-month-old boy attends the emergency department with his mother following a head injury after tripping over at home. He has an obvious large and 'boggy' scalp haematoma. He appears very well and has no clinical signs to suggest intracranial injury. You are unsure if a CT scan is needed and would like to know how much emphasis you should put on this one clinical sign.
Three-part question
In (children presenting with head injury) does (a large, soft scalp haematoma) predict (a positive CT scan for significant cranial injury)
Search strategy
Medline and Embase databases were searched using the interface provided by NHS Evidence the week ending 15 September 2012. The references of relevant major research papers were cross-referenced to ensure all relevant articles were found.
{(infant* OR baby OR babies OR newborn* OR pediatric* OR paediatric* OR child* OR teen* OR neonat* OR adolescen* OR toddler*).ti,ab;} AND {(boggy ADJ2 hematoma*).ti,ab; OR (boggy ADJ2 haematoma*).ti,ab; OR (soft* ADJ2 haematoma*).ti,ab; OR (soft* ADJ2 hematoma*).ti,ab; OR (soft* ADJ2 swell*).ti,ab; OR (boggy* ADJ2 swell*).ti,ab; OR boggy*.ti,ab; OR (scalp* ADJ2 haematoma*).ti,ab; OR (scalp* ADJ2 hematoma*).ti,ab; OR (head* ADJ2 haematoma*).ti,ab; OR (head* ADJ2 hematoma*).ti,ab;} AND {(brain* ADJ2 injur*).ti,ab OR (head* ADJ2 injur*).ti,ab; OR (cerebral ADJ2 injur*).ti,ab; OR (brain* ADJ2 traum*).ti,ab; OR (head* ADJ2 traum*).ti,ab; OR (cerebral ADJ2 traum*).ti,ab; OR exp HEMATOMA/; OR exp CRANIOCEREBRAL TRAUMA/; OR exp BRAIN INJURIES/;}
Search outcome
This resulted in 31 results from Medline and 53 from Embase. Duplicates and articles clearly not relevant were removed, leaving 11 articles for full text evaluation. Of these papers, one directly addressed the clinical question using regression analysis and a second paper was published testing the decision rule produced. Six articles considered the question only as part of a clinical decision rule (CDR); however, three of these provided secondary outcome data, shown in table 1 . One of the CDRs (CHALICE study) considered scalp haematoma along with laceration and bruise and was excluded for this reason....