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Pediatric Skull Fractures: When to Admit

When children hit their heads it can be scary for parents and providers alike. But given the numbers, it might not make sense to reflexively admit. The authors concluded that most children with skull fractures could be managed conservatively. In an editorial accompanying this article it was even suggested that rapid MRI techniques could be substituted for CT scans in head injured children as this would cut down on radiation and the increased risk of missing skull fractures with rapid MRI was unlikely to be important

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 Bursting at the Skull: Skull Fractures

Skull fractures are a common finding in adult trauma patients, with an increase during the summer months when more people are outside riding ATV or other sporting vehicles. Some studies show that basilar skull fracturs are present in 7-15% of all nonpenetrating head trauma.

Articles of Interest

A Review of Basilar Skull Fractures

All patients with basilar skull fractures should be admitted for observation. Management is based on anticipated complications. Most post-traumatic CSF leaks heal with a conservative management of bed rest and head elevation.

Base of Skull Fracture

Persistent leaks >7 days have heightened risk of meningitis and are often surgically repaired

Diagnostic and Clinical Management of Skull Fractures in Children

Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture.

Interpreting Skull Fractures and Their Causes

This blog post focuses on a related topic: skull fractures. This broad term represents an extensive list of 20 specific types of fracture, each with its own etiology (cause) and description. Most fractures can indicate a fall, motor vehicle collision, or other impact to the skull, but some connote assault. Determining the potential cause of a skull fracture can be an important factor in your case. Use the following list to help sort the complexities of skull fracture.

Isolated skull fractures in pediatrics

Pediatric patients with an isolated skull fracture and normal neurological exam have a low risk of neurosurgical intervention and outpatient follow up may be appropriate (assuming no suspicion of abuse and a reliable family).

Linear Skull Fracture

Skull fracture is the most common traumatic finding in kids with abnormal imaging after head injury. Younger children (< 2 years of age, especially infants < 1 year of age) are particularly at risk for skull fracture. Majority of skull fractures can be managed conservatively.

Should pediatric patients with isolated skull fractures be admitted, transferred, or discharged from the emergency department, and what are the economic consequences?

The authors' objective was to evaluate the need for neurosurgical intervention of children with isolated linear skull fractures. None of the children needed surgery and most did not benefit from hospital admission. Based on these findings, a novel emergency department discharge protocol was developed, which can limit unnecessary admissions and lower the burden and added costs for health systems globally.

Understanding Bilateral Skull Fractures in Infancy: A Retrospective Multicenter Case Review

Bilateral skull fractures in infancy often raise suspicion for abuse. Nevertheless, literature suggests that they may occur accidentally. However, empiric data are lacking.

When to Use Point-of-Care Ultrasound for Skull Fractures

Several authors have investigated using POCUS for diagnosing pediatric skull fractures. The sensitivities from these studies range from 82 percent to 100 percent and specificity from 94 percent to 100 percent.

Resources

DDxof.com

Types of Skull Fractures...

Radiopaedia

Skull fractures are best imaged with CT of the brain. Not only is CT sensitive to the detection fractures but it is also able to exquisitely characterize their extent and allow for surgical planning. Furthermore, it is obtained at the same time as the brain is imaged.