Document Detail


Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization?
MedLine Citation:
PMID:  9287884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: We sought to identify the historical factors and physical examination findings typical of infants who have sustained isolated skull fracture (ISF)--in the absence of associated intracranial injury--after head trauma. We also assessed the risk of clinical deterioration (and therefore the need for inpatient observation) in infants with ISF. METHODS: We conducted a retrospective analysis of all patients younger than 2 years admitted to a tertiary care pediatric hospital with a diagnosis of ISF over a 3-year period. RESULTS: During the study period, 101 infants with radiographically proven ISF were admitted to the hospital. Falls were the most common reported mechanism of injury (n = 90 [89%]). Many falls involved short distances: 18 patients (18%) fell less than 3 feet. Nonaccidental trauma was suspected in only 10 patients (10%). Seventy-two patients (71%; 95% confidence interval [CI], 61%, 79%) had at least one of the clinical signs considered potential indicators of serious head injury: initial loss of consciousness, seizures, vomiting, lethargy, irritability, depressed mental status, and focal neurologic findings. In 97 patients (96%; 95% CI, 89%, 98%), local findings of head injury (palpable fracture, soft-tissue swelling, or signs of basilar skull fracture) were noted on physical examination. None of the patients (0%; 95% CI, 0%, 3%) demonstrated clinical decline during hospitalization. All were neurologically normal on discharge. CONCLUSION: A diagnosis of ISF should be considered even in infants with minor mechanisms of head injury who appear well. However, infants with ISF rarely present without local signs of head injury on physical examination. If no other specific clinical concerns necessitate hospital admission, infants with ISF who have reliable caretakers may be considered for discharge home.
Authors:
D S Greenes; S A Schutzman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  30     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-09-25     Completed Date:  1997-09-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  253-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Emergency Medicine, Children's Hospital, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Accidental Falls
Female
Hospitalization*
Humans
Infant
Infant, Newborn
Male
Physical Examination
Retrospective Studies
Skull Fractures / diagnosis*,  etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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