From the Research
Management of Scalp Hematoma Post-Trauma
The management of scalp hematoma post-trauma can vary depending on the severity and location of the hematoma.
- For patients with a soft scalp hematoma presenting to the emergency department more than 24 hours after a head injury, a wait-and-see approach might be more appropriate rather than neuroimaging, if there are no red flags such as neurological symptoms, focal signs on examination, or severe injury mechanism 1.
- Conservative management with non-elastic bandage packing and direct compression can be applied for subgaleal hematoma, and surgery is reserved for cases where non-invasive management fails or severe complications arise 2.
- In cases of minor head injury, scalp hematoma characteristics such as location and size can be associated with increased odds of intracranial injury, and the presence of a scalp hematoma can independently increase the odds of intracranial injury in children and adolescents 3.
Surgical Management
- Surgical management may be necessary for post-traumatic intracranial hematomas, such as acute subdural hematoma, acute epidural hematoma, cerebral contusion, and intracerebral hematoma 4.
- Operative techniques, additional options, and potential pitfalls of surgical intervention for intracranial hematomas should be considered, including wide craniotomy, combined multiple craniotomies, and decompressive craniectomy 4.
Considerations
- The presence of a scalp hematoma can be associated with intracranial injury, and the location and size of the hematoma can increase the odds of intracranial injury 3.
- Linear skull fractures can be present in patients with scalp hematoma and intracranial injury, but the association between scalp hematoma and intracranial injury remains significant even after excluding patients with linear skull fracture 3.
- Delayed-onset subdural hematoma can occur after mild head injury with negative initial brain imaging, and patients should be closely monitored for any changes in their condition 5.