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Understanding Bilateral Skull Fractures in Infancy: A Retrospective Multicenter Case Review
Mandy A O'Hara, Thomas J Valvano1, Marisha Kashyap2
1Department of Pediatrics, Oregon Health and Science University, Portland, OR.
Pediatric Emergency Care
|April 12, 2022
Summary
Bilateral skull fractures in infants can be accidental, often linked to falls. Accidental fractures typically present as simple linear parietal fractures without additional injuries, distinguishing them from abuse-related cases.
Area of Science:
- Pediatrics
- Forensic Medicine
- Radiology
Background:
- Bilateral skull fractures in infants often trigger concerns of non-accidental trauma.
- Empirical data differentiating accidental from abusive bilateral infant skull fractures are limited.
Purpose of the Study:
- To characterize bilateral skull fractures in infants using a large, multicenter dataset.
- To identify features distinguishing accidental from abusive bilateral skull fractures.
Main Methods:
- Retrospective review of medical records for 235 infants (<24 months) with bilateral skull fractures.
- Inclusion of cases with child abuse pediatrician (CAP) consultation across 13 institutions (2005-2020).
- Data collection on history, fracture characteristics, associated injuries, and CAP determination (accident vs. abuse).
Main Results:
- Of 235 cases, 141 were accidental and 94 abusive.
- Accidental fractures were commonly simple linear biparietal fractures (79%) in young infants with a history of falls (70%).
- Abuse cases more frequently showed complex fractures (55%), diffuse intracranial hemorrhage (45%), skin trauma (67%), and additional fractures (49%).
Conclusions:
- A history of falls is frequent in accidental bilateral skull fractures.
- Accidental fractures often involve young infants with simple linear biparietal fractures, lacking associated skin or skeletal trauma.
- Skeletal surveys can assist in differentiating accidental from abusive bilateral skull fractures in unwitnessed infant injuries.
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