Brain trauma in head injuries presenting with and without concurrent skull fractures

Head injuries and skull fractures may be problematic in cause and manner of death. Over a 10-year period, 54 cases showing head injuries were studied. Of these, 34 had skull fractures and 20 had no skull fractures. Virtually all decedents with skull fractures had brain injuries. The most common injury in both groups was motor vehicle accidents (MVA), in which 50% had skull fractures. In cases of skull fracture, brain lacerations, hemorrhages, and cerebral edema were common. Of 20 decedents with head injury but no skull fracture, most were accidents, and all but 3 cases had brain injury, although often relatively minor, except for atlanto-occiptital dislocation. There were significant differences between the two groups. Decedents with skull fractures tended to by younger (mean 35 years) compared to those with head injury only (mean 52 years) (p=0.0021). The use of drugs or alcohol was more likely in decedents with skull fractures than in those with head trauma only (p=0.0431). Mean abbreviated injury scale scores were higher for the face and head/neck of decedents with skull fractures, while significantly lower for chest and extremities, compared to decedents without skull fractures. Brain injury of some kind occurred in 90% of cases of head trauma, so a high level of suspicion should be placed in seeking skull fractures or brain injury.