Infants With Isolated Skull Fracture: What Are Their Clinical Characteristics, and Do They Require Hospitalization?☆,☆☆,★
Section snippets
INTRODUCTION
Historically, screening for skull fractures has been performed in head-injured patients as a means of identifying patients at risk for intracranial injury.1, 2 Older guidelines called for hospitalization and observation of any patient with skull fracture resulting from head trauma.1, 2 As computed tomography (CT) has become widely available as a more definitive measure of intracranial injury, the significance of skull fractures in older children and adults has been called into question. Most
MATERIALS AND METHODS
The setting for the study was Boston Children's Hospital, a 300-bed tertiary care pediatric hospital that serves as a Level I pediatric trauma center and has an annual ED volume of 50,000.
We conducted a retrospective analysis of all children admitted to Children's Hospital between January 1, 1992, and December 31, 1994, who met the following criteria: (1) 24 months or younger, (2) no underlying condition that would make fracture more likely (eg, osteogenesis imperfecta), (3) diagnosis of skull
RESULTS
One hundred one infants younger than 2 years were admitted to Children's Hospital with radiographically proven ISF during the study period. The mean age of these patients was 7.3±5.1 months (range, 2 weeks to 23 months). Ninety-one of the patients (90%) were younger than 1 year.
Thirty-nine of the patients (39%) were girls, 62 (61%) boys. Twenty-nine of the patients (29%) were evaluated first in our ED, and 72 (71%) were referred from another institution after the skull fracture was diagnosed.
DISCUSSION
The data from our series help clarify several issues about infants with ISF. Specifically, our study has been able to demonstrate that (1) infants may sustain ISF—even depressed or multiple fractures—as a result of what, by history, are minor mechanisms of injury; (2) although infants with ISF may appear generally well, the vast majority have some local findings on head examination; and (3) infants with ISF have a very low risk of clinical deterioration.
We have found ISF to be a common reason
Acknowledgements
We thank Dr Karen Gruskin for her help in identifying study subjects and Dr Gary Fleisher for his thoughtful review of the manuscript.
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2018, Annals of Emergency MedicineCitation Excerpt :None of the 6 children with new intracranial hemorrhage required neurosurgery18,27: (1) a 1-month-old child with a fall from 3 feet, with a left parietal skull fracture with a small subdural hematoma on follow-up CT; (2) a 2-year-old child who fell down more than 15 stairs, with a large right parietal skull fracture and a subsequent CT with an extra-axial hematoma; (3) a 2-year-old child with a fall from more than 3 feet, with an occipital fracture and a cerebral contusion on follow-up CT; (4) an 11-year-old child involved in a skateboard crash with an occipital fracture and punctate intracranial hemorrhages on follow-up CT; (5) a 15-year-old adolescent involved in an assault, with an occipital fracture and small parenchymal hemorrhages on follow-up CT; and (6) a child who developed vomiting after overnight observation and had a repeated CT scan that demonstrated a small extra-axial hematoma in the prepontine cistern. Eleven studies4-6,16-19,21,28,31,32 reported on evaluations for nonaccidental trauma (Table 3). Of the 5,799 children included in these studies, 408 underwent any evaluation for nonaccidental trauma (pooled estimate 9.8%; 95% CI 4.6% to 16.6%; I2=97%).
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2018, Journal of PediatricsFacial and Skull Fractures
2017, Fracture Management for Primary Care Updated Edition
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From the Division of Emergency Medicine, Children's Hospital, Boston, MA.
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Reprint no.47/1/83931
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Address for reprints: David S Greenes, MD, Division of Emergency Medicine, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115