Bilateral Parietal Skull Fractures in Infants Attributable to Accidental Falls

Area of Science:

• Pediatric Radiology
• Forensic Pathology
• Biomechanics

Background:

• Bilateral parietal skull fractures (BPSFs) in infants are often presumed indicative of abusive head trauma (AHT).
• Distinguishing between accidental and abusive injuries is critical in pediatric cases.

Purpose of the Study:

• To investigate and describe cases of infant BPSFs resulting from accidental falls.
• To challenge the automatic assumption of AHT in BPSF cases.

Main Methods:

• Retrospective review of infant BPSF cases (<1 year) from a neuroradiology database (2006-2019).
• Inclusion of clinical presentation, injury mechanism, imaging, and expert assessments (child abuse physicians).
• Strict definition of "confirmed accidental BPSF" based on negative skeletal surveys, ophthalmology, and child abuse physician evaluations.

Main Results:

• Identified 12 BPSF cases; 3 were confirmed accidental with a mean infant age of 3 months.
• Accidental BPSFs were associated with single-impact falls or compression injuries, with minor intracranial hemorrhages.
• No associated bruises or other injuries were noted in accidental cases, and infants remained clinically well.

Conclusions:

• While abusive head trauma (AHT) remains a consideration for BPSFs, accidental falls are a plausible mechanism.
• These findings suggest that BPSFs in infants do not always signify abuse.