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Bilateral Skull Fractures in an Infant: Diagnostic Dilemma Between Accident and Abuse
Tomohiro Hirade1, Daisuke Koike1
1Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan, spch.izumo.shimane.jp.
Insights
Infants with bilateral skull fractures require careful evaluation, as this finding can indicate abusive head trauma (AHT) or accidental injury. Prompt medical assessment is crucial for accurate diagnosis and intervention in suspected infant head injuries.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse and Neglect
- Radiology
Background:
- Accidental head injury is common in infants presenting to emergency departments.
- Abusive head trauma (AHT) is a significant cause of infant morbidity and mortality.
- Distinguishing between accidental and abusive head injuries is critical for appropriate management.
Purpose of the Study:
- To highlight the diagnostic challenges in differentiating accidental head injury from abusive head trauma (AHT) in infants.
- To emphasize the importance of a comprehensive medical evaluation when AHT is suspected.
- To discuss the implications of bilateral skull fractures in infant head injuries.
Main Methods:
- Case presentation of a 4-month-old male infant with bilateral scalp swelling.
- Diagnostic imaging including skull radiography and head computed tomography (CT) with 3D reconstruction.
- Review of clinical presentation and imaging findings in the context of differential diagnosis for infant head trauma.
Main Results:
- The infant presented with bilateral parietal skull fractures.
- Bilateral skull fractures, while more common in AHT, can also result from single accidental impacts.
- Skull fracture patterns alone are insufficient to rule out AHT, necessitating further medical evaluation.
Conclusions:
- A high index of suspicion for AHT is warranted in infants with head injuries, including bilateral skull fractures.
- Comprehensive medical evaluation is essential when AHT is suspected.
- Consultation with child protection teams or Child Protective Services is recommended for suspected AHT cases.
Abstract:
Accidental head injury in infants is relatively common in the emergency department. However, abusive head trauma (AHT) should be considered in the differential diagnosis because of its strong association with morbidity and mortality. A 4-month-old male infant was admitted to the emergency department by his parents because of bilateral scalp swelling. Skull radiography and head computed tomography with three-dimensional reconstruction revealed bilateral linear parietal skull fractures. Although bilateral skull fractures are more commonly associated with AHT than single linear skull fractures, they may also result from a single accidental impact. Because skull fracture patterns alone cannot exclude AHT, a comprehensive medical evaluation is essential. If clinicians have even a slight suspicion of AHT, they should not hesitate to consult the hospital child protection team or Child Protective Services.
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