Natural History of Isolated Skull Fractures in Children

Area of Science:

• Pediatric Traumatology
• Neurosurgery
• Pediatric Neurology

Background:

• Head injuries are a leading cause of death and disability in children.
• Isolated skull fractures (SFs) in children can range in severity.
• The necessity of neurosurgical intervention for pediatric SFs requires further clarification.

Purpose of the Study:

• To evaluate the risk of neurosurgical intervention in children with isolated skull fractures and normal neurological examinations.
• To determine the outcomes for pediatric patients presenting with isolated SFs and no intracranial lesions.
• To assess the need for surgical management in this specific pediatric population.

Main Methods:

• Retrospective review of medical records from a Level 1 trauma center (2006-2014).
• Analysis of the National Trauma Data Bank (NTDB) research data set (2012-2014).
• Inclusion criteria: children aged 6-16 years with traumatic brain injuries, specifically isolated SFs and normal neurological exams.

Main Results:

• At the trauma center, 1.9% of 155 children with isolated SFs and normal exams required surgery (for depressed fracture elevation).
• In the NTDB, 4.8% of 5,194 children with isolated SFs and normal exams underwent neurosurgical intervention (craniotomy/elevation).
• No fatalities were reported in either cohort for isolated SFs with normal initial neurological assessments.

Conclusions:

• Children with isolated, non-depressed skull fractures and normal Glasgow Coma Scale (GCS) scores have a minimal risk of mortality.
• Neurosurgical intervention is rarely required for pediatric patients with isolated SFs and a normal neurological presentation.
• Observation and conservative management are often appropriate for pediatric isolated skull fractures without associated intracranial pathology.