A. Abdel Naby1, M. Muhamad2, M. Henry1, D. Hampton1, T. Plackett1 1University Of Chicago, Chicago, IL, USA 2University Of Illinois At Chicago, Chicago, IL, USA
Introduction:
Isolated scalp lacerations are often perceived as minor injuries, but they can be severe and potentially life-threatening due to the significant vascular supply of the scalp leading to substantial blood loss. While these lacerations are generally manageable using basic sutures or staples, fatal hemorrhages can occur if these wounds are left untreated. Owing to their typically benign nature, scalp lacerations have been poorly studied. The present study seeks to characterize these injuries better and explore risk factors associated with mortality.
Methods:
Using the American College of Surgeons’ Trauma Quality Programs Participant Use File (TQP PUF), we studied patients with trauma injuries from 2017-2021. Patients with a scalp laceration were identified and extracted using ICD-10 codes (S01.01XA, S01.02XA) and scalp-related Abbreviated Injury Scale (AIS) PreDot classifications. Patients presenting with multiple ICD-10 diagnosis codes or burns were excluded, to reach the desired population of isolated scalp lacerations. Demographic data obtained included age, sex, race, ethnicity, and mechanism of injury. Admission data obtained included systolic blood pressure (SBP), pulse rate, Glasgow Coma Score (GCS), and Injury Severity Score (ISS). The primary outcome for these patients was mortality. Secondary outcomes were blood product utilization and length of hospitalization.
Results:
Out of 5.5 million patients, 405,827 (7.4%) were diagnosed with scalp lacerations, and 29,434 (0.5%) were isolated scalp lacerations. The patients were predominantly male (59.9%), had a median age of 64 (IQR 42,78), and were almost exclusively the result of blunt trauma (94%). Vital signs on admission include a median SBP of 140 mmHg (IQR 122,158) and a median pulse rate of 86 beats per minute (IQR 73,101). Most patients had a normal GCS score of 15 (72%) and nearly all had low-severity scores of ISS 1-4 (99.5%). Overall, 245 patients died in the emergency department and 222 died after admission to the hospital, leading to an overall mortality rate of 1.6%. On univariate analyses, age, sex, GCS, SBP, pulse rate, blood product utilization, and AIS scores were significantly predictive of mortality (p < 0.001). A chi-squared test of independence showed a significant difference in mortality rates across AIS scores (p < 0.001) with increasing mortality as the AIS rose (Fig. 1).
Conclusion:
While often considered to be minor, data suggests that scalp injuries have serious complications and can be fatal. Further investigation is needed to determine the factors that contribute to the high mortality rate so appropriate preventions can be implemented.