Related Experiment Video
Updated: Apr 27, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Natural history and clinical implications of nondepressed skull fracture in young children
Saif F Hassan1, Stephen M Cohn, John Admire
1From the Department of Surgery, University of Texas Health Science Center, San Antonio, Texas.
Insights
Nondepressed skull fractures (NDSFs) in young children with normal neurologic exams typically do not lead to adverse outcomes. However, those with lower Glasgow Coma Scale scores may experience temporary or persistent deficits.
Area of Science:
- Pediatric neurosurgery
- Trauma care
- Neurology
Background:
- Head injuries are a leading cause of child mortality and disability.
- Skull fractures (SFs) in children are common, with depressed fractures (dSFs) accounting for a significant portion.
- Previous research has focused on dSFs, leaving outcomes for nondepressed SFs (NDSFs) less understood.
Purpose of the Study:
- To investigate the association between nondepressed skull fractures (NDSFs) in children aged 5 years or younger and subsequent neurologic outcomes.
- To determine if NDSFs in this pediatric population correlate with adverse neurologic sequelae.
Main Methods:
- Retrospective review of medical records for children aged 5 years or younger with SFs treated at a Level I trauma center over a 4-year period.
- Data collected included demographics, Glasgow Coma Scale (GCS) scores, injury characteristics, and neurologic deficits.
- Classification of SFs into depressed (dSF) and nondepressed (NDSF) types.
Main Results:
- Out of 223 pediatric SF cases, 163 (73%) were NDSFs.
- In the NDSF group, 128 patients (78%) had a GCS score of 15; none required neurosurgical intervention or developed deficits.
- Among 35 NDSF patients with GCS < 15, 7 (20%) had temporary deficits, 4 (11%) had persistent deficits, and 2 (6%) died.
Conclusions:
- Pediatric patients aged 5 years or younger with NDSFs and a normal neurologic examination at admission show no subsequent neurologic deterioration.
- The presence of a normal neurologic exam is a critical factor in predicting favorable outcomes for NDSFs.
- A subset of NDSF patients with lower GCS scores may still be at risk for neurologic complications.
Background:
Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes.
Methods:
Medical records were reviewed for all children 5 years or younger with SFs who presented to our Level I trauma center during a 4-year period. Data collected included patient demographics, Glasgow Coma Scale (GCS) score at admission, level of consciousness at the time of injury, type of SF (depressed SF vs. NDSF), magnitude of the SF depression, evidence of neurologic deficit, and the requirement for neurosurgical intervention.
Results:
We evaluated 1,546 injured young children during the study period. From this cohort, 563 had isolated head injury, and 223 of them had SF. Of the SF group, 163 (73%) had NDSFs, of whom 128 (78%) presented with a GCS score of 15. None of the NDSF patients with a GCS score of 15 required neurosurgical intervention or developed any neurologic deficit. Of the remaining 35 patients with NDSF and GCS score less than 15, 7 (20%) had a temporary neurologic deficit that resolved before discharge, 4 (11%) developed a persistent neurologic deficit, and 2 died (6%).
Conclusion:
Children 5 years or younger with NDSFs and a normal neurologic examination result at admission do not develop neurologic deterioration.
Level Of Evidence:
Epidemiological study, level III.
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...