Skull fracture and the low risk of intracranial sequelae in minor head trauma

The presence of skull fracture has been associated with a higher risk of intracranial sequelae than if a fracture were not present. This is true for the total population of head-injury patients. However, reanalysis of the patient selection criteria data from two large published series on skull imaging in head trauma revealed that this increased risk factor for intracranial sequelae did not apply to a specific subset of minor-head-trauma patients. The patients in this subset were characterized by the presence of one or more of five "low-yield" criteria: (1) asymptomatic (no complaints), (2) headaches, (3) dizziness, (4) scalp hematoma, and (5) scalp laceration. All other criteria were absent. Results of the reanalysis showed (from a total population of 3031 head-trauma patients) a subset of 1184 patients characterized by these five criteria. In these 1184 minor-head-trauma patients there were 19 fractures, all linear, with none depressed or basilar. There were no intracranial sequelae. This change in the concept of fracture as a risk factor for intracranial sequelae has major implications in the future development of strategies for selecting patients for not having skull films or head computed tomograms.