Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management

Area of Science:

• Pediatric Emergency Medicine
• Neuroradiology
• Pediatric Traumatology

Background:

• Traumatic brain injury (TBI) is a frequent cause of pediatric emergency room visits.
• Mild TBI in children under 2 years old rarely requires surgery, but intracranial findings are crucial for management.
• Linear skull fractures on plain-film X-rays in this age group warrant careful evaluation.

Purpose of the Study:

• To assess the impact of computed tomography (CT) on managing children under 2 years with mild TBI and linear skull fractures.
• To determine the utility of CT scans in identifying significant intracranial injuries in this specific pediatric population.
• To evaluate the rate of abnormal CT findings in children with radiographically confirmed linear skull fractures.

Main Methods:

• Retrospective descriptive study of pediatric patients under 2 years old.
• Analysis of skull X-rays and subsequent CT scans for mild TBI cases.
• Data collected over a 4-year period at a tertiary hospital emergency room.

Main Results:

• 88 CT studies were performed for suspected linear skull fractures; 74 were confirmed (16% false-positive rate).
• Of 74 confirmed fractures, 92% had normal intracranial CT findings.
• Only 2.7% of patients with confirmed fractures required hospitalization >2 days; none required surgery.

Conclusions:

• Routine CT scans are not consistently justified for all children under 2 years with mild TBI and linear skull fractures.
• Individualized imaging strategies based on clinical criteria are recommended.
• CT use should be reserved for cases with a higher risk of intracranial lesions.