Chan KH et al, 1990, Hong Kong | 1178 adolescents (11–15 y) | Prospective | Fracture on plain skull radiograph with ICI | 13 of 26 with skull fracture developed ICI. 10 of these had admission GCS of 15 | Not restricted to mild head trauma |
| ICI without fracture | Of those CTed 4 developed diffuse brain swelling | CTs done selectively |
Levi L et al, 1991, Israel | Sub group of 384 (GSC 13–15) from 653 children = 14 years old analysed from paper. | Prospective | Skull fracture and ICI | Of 97 children, 22% had ICI | |
| No skull fracture and ICI | Of 287 children 15% had ICI | |
Dietrich AM et al, 1993, USA | Sub-group of 233 children with minor head injury and GCS 15, all were head scanned. | Prospective. Cohort | CT results | 11% had isolated skull fracture | Results shown are secondary outcomes of the study. |
| 5% had ICI ± fractured skull, none of whom had abnormal neurology | Not clear if truly prospective |
| Mean age 7.1 yrs, 62% male. | | Plain skull radiographs | 64% of isolated skull fractures were seen on plain skull radiograph | The incidence of skull fracture with ICI was not given |
| (1 Jan 1990 to 31 Dec 1990) | | | No deaths | |
Quayle KS et al, 1997, USA | Data collected in 322 `non-trivial' head injuries. | Prospective cohort | Skull radiograph and head CT | 15.5% had skull fracture ± ICI | 410 children originally identified as `non-trivial' |
| Surgical follow up | 8.4% had ICI | |
| 59% (16) of those with ICI had GCS 15 and no focal neurology. 1 of whom required neurosurgery. | Selective and incomplete data collection on subgroup. |
| Not restricted to mild trauma |
| 6 of these asymptomatic children were <1 year (5/6 had scalp haematoma) | |
Lloyd DA et al, 1997, UK | 883 head injured children | ?Prospective data over 2 years | Skull # on radiograph and CT | 66% of 162 with skull fracture were CTed of which 13% had ICI | Not restricted to mild trauma |
| No skull # and CT | Only 6% of 708 CTed of which 9% had ICI | Only 18% had head CT |
| Remainder went to CT (4 out of 5 who were CTed had ICI with no fracture) or observed only. | Not clearly prospective |
| Up to 23% of skull fractures not seen by ED staff |
Greenes DS and Schutzman SA, 1999, USA | 608 infants <2 years. (11.2 ± 6.8 months, 57% male) | Prospective (selected CT scan). | Imaging | 15.9% of those scanned had ICI - 77% of whom had skull fracture. 27.7% of those imaged had skull fracture diagnosed - 26.1% of whom had ICI. 2.1% of those who were CT scanned had evacuation of haematoma. | Only 31% had head CT, with a further 20% having skull radiograph only. |
| GCS not formally used. |
| Disposition | No deaths | |
Wang MY et al, 2000, USA | 157 children less than 15 years old with field/paramedic GCS (or infant CS) of 13–14 transported by ambulance to a trauma center over twelve month period. | Prospective, multicenter | Head CT results | 27.4% had abnormal CT. 19.1% with intra-cranial haemorrhage - 53% of whom had no fracture. 18.5% had skull fractures - 48% of whom had intra-cranial haematoma. 3.2% had evacuation of intra-cranial haematoma. | Data not available for 52 additional patients who fitted inclusion criteria but were not transported to the trauma center. |
| Disposition | No deaths | No plain radiology. |