Pediatric depressed skull fractures: analysis of 530 cases

Erşahin, Yusuf; Mutluer, Saffet; Mirzai, Hasan; Palali, I.

doi:10.1007/bf00301021

Cited by 59 publications

(40 citation statements)

References 13 publications

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“…In their large series on surgical management of depressed skull fractures in children, Erşahin et al found falls and traffic accidents to be the most common causes of injury. 3 In our study, although a fall was the most common injury in patients overall, those who most frequently had their fracture repaired were hit in the head by an object, and patients who required treatment for their trauma were mostly involved in an MVC. High-impact injuries cause more force to the brain, so it is not surprising that these mechanisms, like MVC, lead to more traumatic injuries.…”

Section: Discussionmentioning

confidence: 63%

“…As in our series, there is a male predominance in most reports on skull fracture. 1,3,9,10,16 The most common cause of injury varies among reports, but mainly lists MVCs, 1,10,15 falls, 3,9,13 and assaults 16 as the predominant mechanisms. However, many of these studies do not differentiate between the age of the patients or those who received surgical treatment for the fracture.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Bonfield¹,

Naran

Adetayo

et al. 2014

PED

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Object Head trauma is a common cause of morbidity and mortality in the pediatric population and often results in a skull fracture. Pediatric skull fractures are distinct from adult fractures. Pediatric fractures have a greater capacity to remodel, but the pediatric brain and craniofacial skeleton are still developing. Although pediatric head trauma has been extensively studied, there is sparse literature regarding skull fractures. The authors' aim was to investigate the characteristics, injuries, complications, and outcomes of the patients in whom surgical intervention was needed for skull fractures. Methods The authors performed a retrospective review of patients presenting to the emergency department of a pediatric Level I trauma center between 2000 and 2005 with skull fractures. Patient demographics, mechanism of injury, associated injuries, fracture bone involvement, surgical intervention, complications, and outcomes were analyzed. Groups treated nonoperatively, for skull fracture repair, and for traumatic brain injury were compared. Results A total of 897 patients with a skull fracture were analyzed. Most patients (n = 772, 86.1%) were treated nonoperatively (Non-Op group). Fifty-eight patients (6.5%) underwent repair of the fracture (Repair group) and 67 (7.5%) required intervention for treatment of traumatic brain injury (TBI group). The Non-Op group was significantly younger, and the TBI group had a lower initial Glasgow Coma Scale (GCS) score. A fall (51.2%) was the most common mechanism of injury in the Non-Op group, whereas a motor vehicle crash (23.9%) and being hit in the head with an object (48.2%) were most prevalent in the TBI and Repair groups, respectively. Associated injuries were seen in all 3 groups, with brain injury (hematoma) being the most common. Frontal bone fracture was seen most in the Repair and TBI groups, and the parietal bone was the most frequent bone fractured in the Non-Op group. Patients in the TBI group were much more likely to have 2 or 3 skull bones fractured. In the Repair group, 36.2% had a complication (38.0% intervention related and 62.0% trauma related), but no patient had a worsening of their neurological status. In the TBI group, 48.7% of the patients suffered a complication, the vast majority (90.6%) of which were related to the trauma. Conclusions The majority of pediatric skull fractures can be managed conservatively. Of those requiring surgical intervention, fewer than half of the surgeries are performed solely for skull fracture repair only. Patients hit in the head with an object or involved in a motor vehicle crash are more likely to need surgical intervention either to repair the skull fracture or for TBI management, respectively. Frontal bone fractures are more likely to necessitate repair, and those patients treated for TBI have a greater incidence of 2 or 3 bones involved in the fracture. Complications occurred but most were related to underlying trauma, not the surgery. No patients who underwent intervention for repair of their skull fracture only had a worsening of their neurological status.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Bonfield¹,

Naran

Adetayo

et al. 2014

PED

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“…The most common MOI in our study was falls, which has been noted as a predominant cause of skull fractures in previous publications. 3,4,10 In…”

Section: Discussionmentioning

confidence: 99%

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Arrey

Kerr

Fletcher

et al. 2015

PED

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OBJECT In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed. METHODS After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children’s hospital between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus. RESULTS Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36 (11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7–395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2–43 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit. CONCLUSIONS Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.

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“…Approximately 4-13% of brain abscesses in children are a result of cranial injuries. 19,28,108 For example, many children have sustained penetrating ocular injuries as a result of experimenting with sharp objects such as pencils and sticks, and intracranial extension may lead to an abscess. 4,32,43 The incidence of brain abscesses secondary to penetrating cranial injuries in children has been reported to range from 4.8 to 16%.…”

mentioning

confidence: 99%

Management of brain abscesses in children

Frazier¹,

Ahn²,

Jallo³

2008

FOC

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✓ Brain abscesses occur infrequently but continue to be problematic for the pediatric neurosurgical community. The incidence of brain abscesses in children has not changed much, although individual reports may show an increase or decrease in the number of reported cases depending on the patient population studied. An increase could be attributed to earlier detection due to advancements in imaging modalities and/or to an increase in the number of children with immunodeficient states caused by AIDS, chemotherapy for malignant lesions, and immunosuppressive therapy for organ transplantation. A decrease in the incidence of brain abscesses could be attributed to practices such as antibiotic treatment for otitis media, sinusitis, and/or prophylactic antimicrobial treatment for congenital heart disease in children. The morbidity and mortality rates associated with brain abscesses have not changed dramatically in the antibiotic and imaging era, and their preferred management can vary among healthcare providers. These lesions have been successfully treated by neurosurgeons. The causes of brain abscesses are highly variable in children, which is also the case in adults, but the predisposing factors in the pediatric population differ in prevalence. Cyanotic congenital heart disease, hematogenous dissemination, contiguous infection, and penetrating traumatic injuries are the most common causes of brain abscesses in children. In this review, the authors discuss the causes and medical and surgical management of brain abscesses in children.

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Pediatric depressed skull fractures: analysis of 530 cases

Cited by 59 publications

References 13 publications

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Management of brain abscesses in children

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