Evaluation of isolated skull fractures in children
Sommer L Glasgow1, Jack H Scaife1, Christopher E Clinker1
1University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, USA.
Insights
Pediatric isolated skull fractures without intracranial hemorrhage (ICH) are low risk. Children with nondisplaced or minimally displaced fractures and normal exams need no repeat imaging or neurosurgical consultation.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Radiology
Background:
- The Brain Injury Guidelines for Kids (kBIG) adapted adult guidelines for pediatric patients.
- Children frequently present with isolated skull fractures without intracranial hemorrhage (ICH).
- A kBIG 0 category was created for these injuries, necessitating further characterization.
Purpose of the Study:
- To characterize isolated skull fractures in pediatric patients.
- To evaluate the risk of ICH development and neurosurgical intervention in these cases.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) with isolated skull fractures.
- Data included demographics, injury characteristics, fracture location, repeat head CT, and neurosurgical intervention.
- Fractures classified as nondisplaced, minimally displaced, or displaced.
Main Results:
- 63% nondisplaced, 27% minimally displaced, 10% displaced fractures observed in 431 children.
- ICH progression occurred in 1.4% of patients, primarily those with low GCS or suspected hemorrhage.
- 4.4% required neurosurgical intervention, mainly for displaced fractures or low GCS.
Conclusions:
- Children with isolated, nondisplaced/minimally displaced skull fractures and normal neurological exams have excellent outcomes.
- Repeat imaging is not required for these patients.
- Neurosurgical consultation is unnecessary for stable pediatric isolated skull fractures with normal exams.
Background:
The Brain Injury Guidelines (BIG) was recently adapted to pediatric patients by developing a pediatric-specific risk stratification algorithm, BIG for Kids (kBIG).(1) Children differ from adults in injury patterns and have a higher prevalence of isolated skull fractures without intracranial hemorrhage (ICH). Given the frequency of this injury pattern, a distinct kBIG 0 category was created. This study aimed to better characterize isolated skull fractures in children. We hypothesized that these fractures carry a low risk of ICH development or neurosurgical intervention.
Methods:
We conducted a retrospective cohort study of pediatric patients (<18 years) with isolated skull fractures treated at a Level 1 pediatric trauma center from January 2018 to April 2024. Data collected included demographics, injury characteristics, location of fracture, repeat head CT, and neurosurgical intervention. Fractures were classified as nondisplaced, minimally displaced (< one cranium width), or displaced (≥ one cranium width).
Results:
Among 431 children, 63 % had nondisplaced, 27 % minimally displaced, and 10 % displaced fractures. Fracture locations most commonly involved the parietal, frontal, and occipital bones. ICH progression occurred in six patients (1.4 %), all with low Glasgow Coma Scale rating (GCS) or suspected hemorrhage. Nineteen patients (4.4 %) required neurosurgical intervention: six had GCS <15, and 13 had displaced fractures requiring fracture elevation. Fracture location was nonsignificant. No patient with a normal neurologic exam and a nondisplaced or minimally displaced fracture required surgery.
Conclusion:
Children with isolated, nondisplaced or minimally displaced skull fractures and normal neurological exams had excellent outcomes. These patients do not require repeat imaging or neurosurgical consultation.
More Related Videos
07:01A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...