SKULL FRACTURES IN CHILDREN - ALTERED CONSCIOUS LEVEL IS THE MAIN INDICATION FOR URGENT CT SCANNING

It has been suggested that all children with skull fractures require u rgent CT scanning to exclude intracranial injury. Adhering to such a p olicy could both tar limited scanning facilities and result in unneces sary exposure to radiation. The aim of this study is to assess the lev el of consciousness in determining the need for urgent CT scanning, an d the possible role of the mechanism of injury as a secondary risk fac tor. We identified 140 children admitted during a 7-year period with a skull fracture after falling outside the home. Thirteen children herd a diminished level of consciousness. Scans were performed in nine, an d seven of the scans revealed significant intracranial injuries. By co mparison, all 127 children with a normal level of consciousness recove red fully. Scanning was performed in only eight of them; seven scans w ere normal and one revealed a small subarachnoid haemorrhage which did not require active treatment. In addition, all 13 children with a dim inished level of consciousness had sustained their injuries by falling from greater than their own standing height. By comparison, none of t he children who had sustained their skull fractures by tripping up had ct diminished level of consciousness or a significant intracranial in jury. We conclude that all children with a diminished level of conscio usness need to undergo an urgent CT scan. Children with skull fracture s and a normal conscious level may be managed initially by neuroobserv ations and the clinician may be further reassured if the child's injur y resulted from tripping up.