SKULL FRACTURES IN CHILDREN - A POPULATION STUDY

Objective-To provide information about children with a skull fracture in the Edinburgh area, since head injury is the single most important traumatic cause of death in children over 1 year of age. Methods-Durin g the period January 1983 to December 1989, all children in the Edinbu rgh area under 13 years of age who sustained a skull fracture were ide ntified. Details of the children who died primarily from a head injury , and the total number of children who were admitted to hospital with a head injury not associated with a skull fracture, were also document ed. Data were obtained from the General Register Office for Scotland, Edinburgh Fiscal Office records, and Lothian Health Board records. Dat a on cause of injury and clinical condition were obtained. Results-349 8 children under 13 years of age were admitted to hospital after susta ining a head injury and 27 died primarily as a result of their injurie s; 409 children had a skull fracture and 76 of this group had cranial CT scans. Nineteen of the CT scans performed were on children who had been admitted to hospital in a coma, and all had abnormal scan finding s. In addition all children with intracerebral haematomas/haemorrhages had been admitted in a coma. Road traffic accidents accounted for the greatest number of deaths (84%), associated injuries, and overall mor bidity. Conclusions-To reduce the incidence of head injuries, and the associated morbidity and mortality, the following are required: identi fy at risk groups; promote accident prevention; publicise the findings and guidelines concerning childhood head injuries; ensure that all ch ildren with head injuries have appropriate investigations and begin tr eatment as early as possible; establish clinical audit; and set up reg ional rehabilitation teams.