Infant scalp score: how the age and scalp hematoma points add up
The infant scalp score adds three parts: age points (3 for 0 to 2 months, 2 for 3 to 5 months, 1 for 6 to 11 months, 0 from 12 months), hematoma size points (0 to 3) and hematoma location points (0 to 2). The total runs from 0 to 8.
Not a medical device. Not a diagnosis or dosing recommendation.
What is the infant scalp score?
The infant scalp score comes from Greenes and Schutzman, published in Pediatric Emergency Care in 2001. It looks at three things after a head bump in a baby who otherwise seems well: how young the baby is, how big any scalp swelling (hematoma) is and where on the head it sits.
Magent's calculator returns the total and its maximum of 8. It doesn't return a risk group, and it doesn't say whether a scan is needed.
This page explains how the points add up. It doesn't say what a score means for a particular baby.
The infant scalp score formula
Age points 0–2 months → 3 · 3–5 → 2 · 6–11 → 1 · 12 or more → 0
Hematoma size none 0 · small 1 · medium 2 · large 3
Hematoma location frontal 0 · occipital 1 · temporal/parietal 2
Score = age points + size points + location points (0 to 8)Exact expression the calculator uses:
Infant Scalp Score = age_points + hematoma_size + hematoma_location; age 0-2 mo → 3, 3-5 → 2, 6-11 → 1, ≥12 → 0; size caller-assigned 0-3; location 0 frontal / 1 occipital / 2 temporal-parietal; max 8Inputs
| Input | What you enter | Points |
|---|---|---|
age_months | Age in completed months, whole number 0 to 24 | 3, 2, 1 or 0 by age |
hematoma_size | Size points you assign: 0 none, 1 small, 2 medium, 3 large | 0 to 3 |
hematoma_location | Location points you assign: 0 frontal, 1 occipital, 2 temporal/parietal | 0 to 2 |
How the calculation works
- Age points: 0 to 2 months scores 3, 3 to 5 months scores 2, 6 to 11 months scores 1, and 12 months or more scores 0.
- Size points: use the number you assigned, 0 to 3.
- Location points: frontal (forehead) 0, occipital (back of the head) 1, temporal or parietal (side of the head) 2.
- Add the three for a total from 0 to 8.
The calculator doesn't set centimeter cutoffs for small, medium or large. You decide the size category.
Units
Age is in completed months. The calculator doesn't convert days or years, so a baby of 1 year and 1 month is entered as 13. Size and location are point values with no units. An age outside 0 to 24 or a size or location value outside its list is rejected with an error.
Worked examples
These use Magent's own expected values for the calculator.
Example 1: 13 months, no hematoma
- 13 months → 0. Size 0. Location 0 (frontal).
- Total 0.
Example 2: 13 months, small frontal hematoma
- Age 0 + size 1 + location 0.
- Total 1.
Example 3: 1 month, no hematoma
- 1 month → 3. Size 0. Location 0.
- Total 3.
Example 4: 1 month, small frontal hematoma
- Age 3 + size 1 + location 0.
- Total 4.
Example 5: 1 month, large temporal/parietal hematoma
- Age 3 + size 3 + location 2.
- Total 8, the maximum.
History of the infant scalp score
The calculator cites Greenes DS and Schutzman SA, Clinical significance of scalp abnormalities in asymptomatic head-injured infants, Pediatric Emergency Care, 2001. The abstract describes a prospective study of head-injured infants up to 24 months old who had no signs of brain injury, seen in an urban children's hospital emergency department. The authors looked at age, hematoma size and hematoma location against skull fracture and injury inside the skull. Larger hematomas went with more skull fractures in a stepwise way. Parietal and temporal hematomas were strongly linked with skull fracture and frontal ones were not; younger age showed a weaker link. The authors proposed a decision rule and said it should be tested in other groups of patients.
When it's used
The 2001 study looked at babies up to 24 months old with a head injury who showed no signs of brain injury.
Where it's used
The score needs age in months and what the scalp looks like. No lab value or scan result goes into it.
Who uses it
The person using the calculator enters age and assigns size and location points. The calculator adds them.
Limits of the calculation
- The calculator doesn't examine the baby, look at the scalp or measure the hematoma.
- It returns a total, not a risk group. Later cutoffs and website low/high labels aren't applied.
- It doesn't decide whether a CT scan or other imaging is needed.
- It covers ages 0 to 24 months, entered as whole months.
- This page doesn't say what to do with a score.
Clinical decisions belong to a qualified clinician who knows the patient.
How it differs from related calculators
- PECARN head uses prediction trees for clinically important brain injury and returns a risk group.
- CATCH uses seven findings and returns a risk group.
- CHALICE uses history, examination and mechanism findings.
Glossary
- Scalp hematoma: a collection of blood under the scalp that shows as a swelling.
- Frontal: the forehead area.
- Occipital: the back of the head.
- Temporal/parietal: the side and upper side of the head.
Common mistakes
- Entering age in years. Use completed months: 13, not 1.
- Giving a frontal hematoma location points. Frontal scores 0.
- Expecting a risk group. The calculator returns the total and nothing else.
- Reading size as a measurement. It's a 0 to 3 category you assign.
Source
Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care. 2001;17(2):88-92. DOI: 10.1097/00006565-200104000-00002. PMID: 11334100
Frequently asked questions
How is the infant scalp score calculated?
Add age points (3, 2, 1 or 0), hematoma size points (0 to 3) and location points (0 to 2).
What is the highest infant scalp score?
8: a baby 0 to 2 months old with a large temporal or parietal hematoma.
Does the calculator say whether imaging is needed?
No. It returns the total, not an imaging decision.
How does the calculator define a small or large hematoma?
It doesn't. You assign the size category.
What age does the score cover?
0 to 24 months, entered in whole months.