What is the treatment for a mild subgaleal hematoma due to head injury?

Treatment for Mild Subgaleal Hematoma Due to Head Injury

Conservative management with close observation is the recommended treatment for mild subgaleal hematomas, as most cases resolve spontaneously without the need for aspiration or drainage.

Initial Assessment and Management

• Evaluate for signs of neurological deterioration:

  • Changes in level of consciousness
  • Focal neurological deficits
  • Severe headache
  • Vomiting
  • Visual disturbances

• Imaging considerations:

  • CT scan is the first-line imaging modality to rule out intracranial hemorrhage or skull fractures 1
  • MRI may be considered in specific situations when CT findings don't adequately explain clinical status 2

Treatment Algorithm

For Uncomplicated Mild Subgaleal Hematoma:

1. Conservative management:

   • Close observation
   • Mild analgesics for pain control
   • Application of non-elastic bandage compression if needed 3
   • Avoid activities that increase intracranial pressure for 4-6 weeks 2

2. Follow-up schedule:

   • Clinical follow-up every 2-4 weeks until resolution 2
   • Repeat imaging in 4-8 weeks if symptoms persist or worsen 2

3. Patient education:

   • Warning signs requiring immediate medical attention:
     • New-onset severe headache
     • Confusion
     • Decreased level of consciousness
     • Progressive swelling 2

For Patients on Anticoagulation:

1. Consider temporary discontinuation if hematoma is enlarging 2
2. Wait 3-4 weeks after stabilization before restarting anticoagulation 2
3. Obtain follow-up imaging to confirm stability before resuming anticoagulation 2

Special Considerations

Anticoagulation Management

• High-risk patients may consider earlier restart at 2-3 weeks with careful monitoring
• Lower-risk patients should wait the full 4 weeks before restarting anticoagulation 2
• For patients on antiplatelet therapy, resumption can generally occur 4-8 weeks after stabilization 2

When to Consider Surgical Intervention

Surgical evacuation should be considered if:

• Signs of significant mass effect develop
• Neurological deterioration occurs
• Hematoma continues to expand despite conservative measures 2

Evidence and Outcomes

Multiple studies support conservative management for subgaleal hematomas:

• A study of subgaleal hematomas found that most cases resolve spontaneously within 10 days, even in patients on anticoagulation 4
• International Surgery reported that most hematomas spontaneously resolved within four weeks of injury 5
• A case report of a 19-month-old with extensive subgaleal hematoma recommended conservative treatment except in select severe cases 6

Pitfalls and Caveats

• Don't underestimate anticoagulation risk: Patients on anticoagulants may develop significant subgaleal hematomas even after mild trauma 4
• Watch for delayed expansion: Some hematomas may continue to expand hours after the initial injury, requiring repeat imaging if symptoms worsen 4
• Monitor for anemia: Large subgaleal hematomas can cause significant blood loss leading to anemia, requiring hemoglobin monitoring 6
• Don't miss associated injuries: Always evaluate for concurrent intracranial injuries or skull fractures that may require different management 1

The evidence strongly supports that conservative management with close observation is the most appropriate treatment for mild subgaleal hematomas, with surgical intervention reserved only for cases with neurological deterioration or significant mass effect.