INFANTS WITH ISOLATED SKULL FRACTURE - WHAT ARE THEIR CLINICAL CHARACTERISTICS, AND DO THEY REQUIRE HOSPITALIZATION

Study objective: We sought to identify the historical factors and phys ical examination findings typical of infants who have sustained isolat ed skull fracture (ISF)-in the absence of associated intracranial inju ry-after head trauma. We also assessed the risk of clinical deteriorat ion (and therefore the need for inpatient observation) in infants with ISF. Methods: We conducted a retrospective analysis of ail patients y ounger than 2 years admitted to a tertiary care pediatric hospital wit h a diagnosis of ISF over a 3-year period. Results: During the study p eriod, 101 infants with radiographically proven ISF were admitted to t he hospital. Falls were the most common reported mechanism of injury ( n=90 [89%]). Many falls involved short distances: 18 patients (18%) fe ll less than 3 feet. Nonaccidental trauma was suspected in only 10 pat ients (10%). Seventy-two patients (71%; 95% confidence interval [CI], 61%, 79%) bad at least one of the clinical signs considered potential indicators of serious head injury: initial loss of consciousness, seiz ures, vomiting, lethargy, irritability, depressed mental status, and f ocal neurologic findings. In 97 patients (96%;95% CT, 89%, 98%), local findings of head injury (palpable fracture, soft-tissue swelling, or signs of basilar skull fracture) were noted on physical examination. N one of the patients (0%; 95% CI, 0%, 3%) demonstrated clinical decline during hospitalization. All were neurologically normal on discharge.C onclusion: A diagnosis of ISF should be considered even in infants wit h minor mechanisms of head injury who appear well. However, infants wi th ISF rarely present without local signs of head injury on physical e xamination. If no other specific clinical concerns necessitate hospita l admission, infants with ISF who have reliable caretakers may be cons idered for discharge home.