Skull Fracture in an Infant Not Visible with Computed Tomography

Fleece, David; Kochan, Polly S.

doi:10.1016/j.jpeds.2008.12.008

Cited by 6 publications

(2 citation statements)

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“…As a result, literature describing pediatric nonaccidental traumatic cranial bony features was assessed only via conventional skull radiography 10–13 . In addition, historically, axially acquired head CT imaging had been shown to miss linear skull fractures that run parallel/in plane to the axial acquisition slice 16,24–27 . As a result, conventional skull radiographs remained the mainstay of pediatric skull traumatic imaging with 2-view skull radiographs (AP and lateral view) as a standard component of skeletal surveys for suspected nonaccidental trauma.…”

Section: Discussionmentioning

confidence: 99%

Cranial Suture Evaluation in Pediatric Head Trauma

2021

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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.

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Section: Discussionmentioning

confidence: 99%

Cranial Suture Evaluation in Pediatric Head Trauma

2021

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“…Subgaleal hematomas are primarily associated with trauma, and lack of a trauma history or injury does not preclude the need for further investigation. 1,2 Presentation of this condition from a bleeding diathesis is rare. 3,4 The injuries associated with subgaleal hematomas vary from minor trauma such as hair braiding to major trauma secondary to child abuse.…”

Section: Discussionmentioning

confidence: 99%