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Delays in care seeking for young children with accidental skull fractures are common
James B Metz1, Jeffrey P Otjen2, Francisco A Perez2
1Department of Paediatrics, University of Vermont Children's Hospital, University of Vermont, Burlington, Vermont, USA.
Insights
Delayed medical care for young children with accidental skull fractures is common after minor incidents, often due to delayed symptom onset. This pattern in infant and toddler skull fractures doesn't necessarily indicate child abuse.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Accidental skull fractures in young children can present diagnostic challenges.
- Understanding care-seeking patterns is crucial for accurate diagnosis and intervention.
Purpose of the Study:
- To determine the frequency and patterns of delayed medical care seeking in young children with accidental skull fractures.
- To identify factors associated with delayed presentation.
Main Methods:
- Retrospective study of accidental skull fractures in children under 4 years old (2011-2012).
- Data abstracted by child abuse pediatricians and images re-reviewed by pediatric radiologists.
- Care delay defined as presentation ≥6 hours post-injury; minor vs. major accidents categorized by fall height and force.
Main Results:
- 210 children had accidental skull fractures; delays were more frequent with minor accidents (25.8%) than major accidents (4.9%).
- Common reasons for seeking care included scalp swelling (39%), the injury event (36.2%), altered consciousness (15.2%), and vomiting (10.5%).
- Delayed onset of scalp swelling was the primary driver of delayed care (78.6%).
Conclusions:
- Delayed care seeking is prevalent in minor accidental infant and toddler skull fractures, often linked to delayed symptom manifestation.
- Delayed presentation alone should not be misconstrued as indicative of child abuse.
- Distinguishing between minor and major accidents is key to understanding care-seeking delays.
Aim:
We sought to determine the frequency and patterns of delayed medical care seeking for young children with skull fractures.
Methods:
We identified accidental skull fractures <4 years old, 2011-2012. Child abuse paediatricians abstracted retrospective data and paediatric radiologists re-reviewed images. 'Delays' were defined as presentation at ≥6 h. 'Minor accidents' included falls <4 feet and low force trauma, while 'major accidents' included higher height falls and major force events. We studied the frequency and duration of care delays, the signs or symptoms leading to care, and the duration of delays after signs or symptoms developed.
Results:
Two hundred and ten children had accidental skull fractures. Delays were less likely with major accidents (4.9%), than with minor accidents (25.8%) (RR = 0.32 [0.15-0.70]). Children came to care for scalp swelling (STS) (39%), the injury event (36.2%), altered consciousness (15.2%) and vomiting (10.5%). Delayed onset of STS (78.6%) caused most delayed care. Early STS was firm, (17.6%) versus delayed (5.0%), as opposed to soft or fluctuant.
Conclusion:
Delayed care seeking is common for minor, but not major accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.
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