Cranial Suture Evaluation in Pediatric Head Trauma

Abstract

Objectives: Pediatric skull fracture association with the cranial sutures (crossing, widening, or contacting 2 or more cranial sutures) is suggestive of abusive injury. We studied the efficacy of head computed tomography (CT) versus skull radiographs in identifying pediatric skull fracture association with cranial sutures and reviewed head CT literature recommendations for pediatric head trauma.Methods: Retrospective review was performed of skull radiographs and head CT at a tertiary care, free-standing children's hospital (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Statistical 2-proportion Z test determined efficacy of head CT versus skull radiographs in assessing cranial suture involvement with fractures.Results: Forty-seven children with 56 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated, ages 1 to 36 months. Of the 110 total skull fractures evaluated, 51 abusive and 41 accidental skull fractures had terminal ends contacting cranial sutures for a total of 92 (84%). Twelve abusive fractures (24%) crossed sutures; no accidental fractures crossed sutures (P < 0.01). Of the 12 abusive cases with skull fractures that crossed sutures, 7 were definitively identified only on CT (P < 0.01). Widened sutures were documented in 4 (8%) of the abusive cases with skull fracture; none in the accidental cases. All 4 of these cases were equally identified on both skull radiography and CT imaging. In 21 of 47 abusive versus 5 of 47 accidental cases, CT identified skull fractures lines that extended to cranial sutures that were not definitive on skull radiography (P = 0.00022).Conclusions: Cranial suture involvement with pediatric skull fractures is common. Head CT significantly aided in the identification of skull fractures contacting and crossing cranial sutures in abusive cases, supporting eliminating concurrent skull radiographs.

Acute Computer Tomography Findings in Pediatric Accidental Head Trauma-Review

“… 9 , 18 Both in accidental and non-accidental head traumas fractures can come in contact with one skull suture, but in accidental trauma it is rare for the fracture to touch more sutures. 19 , 20 Depressed fractures happen when there is an impact with a blunt object, and there is also high energy transferred to a small area of the skull. The bone fragment/fragments are inwardly depressed and there can also be other linear fragments associated.…”