Advice
- Not all head-injured infants require evaluation for nonaccidental trauma, but the possibility should always be considered, particularly in infants who are not yet walking or cruising.
- Skull X-rays have poor sensitivity for ruling out skull fractures (especially smaller or nondisplaced ones) and cannot evaluate for the presence/absence of traumatic brain injury; as such, they have limited clinical utility.
Management
- For patients with a score <4, head imaging may not be necessary.
- For patients with a score ≥4, head imaging (usually with a CT) should be considered.
- Some studies have recommended a cutoff of ≥5 for ciTBI.
- As with all risk assessment scores, clinical judgment is essential.
Critical Actions
- This tool should not be used in infants for whom nonaccidental trauma is a concern; follow institutional protocols for head imaging decisions in these cases, and strongly consider consultation with a child abuse pediatrician.
- Even when the chief complaint is head injury, evaluate for other injuries.