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Appropriate imaging in children with skull fractures and suspicion of abuse
K I Mogbo1, T L Slovis, A I Canady
1Department of Pediatric Imaging, Children's Hospital of Michigan, Detroit 48201-2196, USA.
Insights
Computed tomography (CT) scans are often unnecessary for young children with head trauma and normal neurological exams. Head CTs did not change management or outcomes for children without neurological findings, suggesting routine imaging may not be needed.
Area of Science:
- Pediatric radiology
- Neuroradiology
- Child abuse evaluation
Background:
- Skull fractures in young children can be indicative of abuse.
- The role of advanced imaging like computed tomography (CT) in evaluating these cases is crucial.
Purpose of the Study:
- To determine the utility of CT scans in children aged 2 years and younger with head trauma, suspected abuse, and normal neurological findings.
- To assess whether CT imaging impacts clinical management or outcomes in this specific pediatric population.
Main Methods:
- Retrospective review of 87 children under 2 years old with skull fractures on plain radiography, evaluated for suspected abuse between 1992 and 1995.
- Analysis of CT scan findings and clinical outcomes for children with and without acute neurological findings.
Main Results:
- In children with normal neurological findings, CT scans revealed acute intracranial injury in only 19% of those who underwent imaging.
- CT scans did not alter clinical management, clinical outcome, or legal outcomes for children with normal neurological findings.
- In children with acute neurological findings, 80% had positive CT scans, leading to neurosurgical intervention in 45%.
Conclusions:
- CT imaging is unlikely to reveal clinically significant abnormalities in young children with head trauma, suspected abuse, and normal neurological status.
- Routine head CT scans may be unnecessary for all pediatric patients with skull fractures, particularly those without neurological deficits.
- The decision to perform CT should be individualized based on clinical presentation and neurological examination findings.
Purpose:
To define the role of computed tomography (CT) in children aged 2 years and younger with head trauma, suspected abuse, and normal neurologic findings.
Materials And Methods:
From 1992 through 1995, 87 consecutive children with skull fractures visible at plain radiography were referred to child protective services for evaluation of suspected abuse. Their cases were retrospectively reviewed.
Results:
Of 67 children with normal neurologic findings, 35 (52%) were not referred for CT. No patient in this group developed delayed findings requiring further evaluation. Of the 32 (48%) who underwent head CT, only six (19%) had evidence of acute intracranial injury, despite the presence of minimal depression and stellate, multiple, and diastatic fractures. Of 20 children with acute neurologic findings, 16 (80%) had positive CT scans, which led to neurosurgical intervention in nine (45%).
Conclusion:
No child with normal neurologic findings had a clinically important abnormality depicted at CT. CT scans did not alter clinical management, clinical outcome, or legal outcome. Thus, routine CT of all patients with skull fractures in this population may be unnecessary.