SKULL FRACTURE IN INFANTS AND PREDICTORS OF ASSOCIATED INTRACRANIAL INJURY

Background. Emergency department (ED) management of skull fractures in children remains controversial, Because infants incurring head trauma have a high incidence of skull fracture, we chose to describe fractur es in this subset of patients and to determine if there are clinical p redictors of associated intracranial injury (ICI) that may have utilit y in developing more efficient management schemes in these patients. M ethods; A retrospective medical record review was conducted on all awa ke patients < 13 months of age with an acute skull fracture from non-b irth trauma, presenting to the ED of a university-affiliated children' s hospital during a three-year period, Clinical and radiographic data extracted were used to describe skull fractures in these patients, The ability of various characteristics to determine the presence of ICI w as assessed by calculating sensitivity, specificity, positive predicti ve value, and negative predictive value for each. Results. The predomi nant mechanism of injury for the 102 infants was falls (91%), Suspicio n of abuse was found in only one case, The parietal bone was fractured in 87 infants, and 34 had nonparietal fractures, The most prevalent f racture type was linear (92 infants), and 31 had > 1 cranial bone frac tured, CT scans obtained on 32 infants (CT group) revealed 21 ICIs in 15 patients, Two with temporoparietal fractures required emergent evac uation of epidural blood, In the CT group, seven of the 15 (47%) with ICI (ICI group) were lethargic compared to two of the 17 (12%) without ICI (No ICI group) (P = 0.035), Five (33%) in the ICI group had tempo ral bone fractures compared to 0 in the No ICI group (P = 0.015), The presence of any sign or symptom had a sensitivity and negative predict ive value of 100%, but only a specificity of 35%. The presence of leth argy had a positive predictive value of 78%, The presence of temporal and frontal bone fractures had positive predictive values of 100 and 7 5%, respectively. Conclusion, This study reports a high prevalence of fracture characteristics often associated with inflicted injury in oth er studies when virtually all injuries in our sample were accidental, Several clinical characteristics were demonstrated to be potentially u seful in predicting ICI associated with skull fracture; however, prosp ective study is recommended to validate these findings prior to clinic al application.