Skip to main content
Log in

Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

To determine whether skull fractures can be used to associate intracranial hemorrhage with minor head trauma (MHT).

Objective

We conducted a retrospective study evaluating the association between linear skull fractures and intracranial hemorrhage among children with MHT. Furthermore, we evaluated the significance of small intracranial hemorrhages by assessing the need for neurosurgical interventions.

Materials and methods

The case group included 114 children with a diagnosis of a linear skull fracture and the control group included 125 children without the diagnosis. We conducted multivariable logistic regression analyses to estimate the odds ratio (OR) between linear skull fractures and intracranial bleeding.

Results

Among the cases, 29 of 114 (25%) children were diagnosed with an intracranial hemorrhage on CT, compared to only 14 of 125 (11%) among the controls. The multivariable OR for intracranial hemorrhages comparing cases and controls adjusted for age and gender was 2.17 (95% confidence interval [CI]: 1.01, 4.68). All the intracranial hemorrhages were small (3.8 ± 2.3 mm) and none of them required any neurosurgical intervention.

Conclusion

The presence of a linear skull fracture is an independent risk factor for intracranial hemorrhage. However, all the intracranial hemorrhages associated with the skull fractures were small and did not require any neurosurgical interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Blackwell CD, Gorelick M, Holmes JF et al (2007) Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time. Ann Emerg Med 49:320–324

    Article  PubMed  Google Scholar 

  2. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  3. Rice H, Frush D, Farmer D et al (2007) Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg 42:603–607

    Article  PubMed  Google Scholar 

  4. Campbell KA, Berger RP, Ettaro L et al (2007) Cost-effectiveness of head computed tomography in infants with possible inflicted traumatic brain injury. Pediatrics 120:295–304

    Article  PubMed  Google Scholar 

  5. Durham SR, Liu KC, Selden NR (2006) Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 105:365–369

    PubMed  Google Scholar 

  6. Shireen M, Atabaki MD, Stiell IG et al (2008) A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med 162:439–445

    Article  Google Scholar 

  7. Holmes JF, Vance CW, Gelber RE et al (2003) A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 42:492–506

    Article  PubMed  Google Scholar 

  8. Mower WR, Hoffman JR, Herbert M et al (2005) Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma 59:954–959

    Article  PubMed  Google Scholar 

  9. Hofman PA, Nelemans P, Kemerink GJ et al (2000) Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry 68:416–422

    Article  CAS  PubMed  Google Scholar 

  10. Carty H, Patterson M, Butcher CK et al (1997) Predictive value of skull radiography for intracranial injury in children with blunt head. Lancet 349:821–824

    Article  PubMed  Google Scholar 

  11. Letourneau P, Vitorino E, McCall J (2001) Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma 51:231–237

    Article  PubMed  Google Scholar 

  12. Qualle KS, Jaffe DM, Kuppermann N et al (1997) Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated. Pediatrics 99:E11

    Article  Google Scholar 

  13. Holsti M, Kadish HA, Sill BL et al (2005) Pediatric closed head injuries treated in an observation unit. Pediatr Emerg Care 21:639–644

    Article  PubMed  Google Scholar 

  14. Golden N, Maliawan S (2005) Clinical analysis of non-accidental head injury in infants. J Clin Neurosci 12:235–239

    Article  CAS  PubMed  Google Scholar 

  15. Jagoda AS, Cantrill SV, Wears RL et al (2002) Clinical policy: neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med 40:231–249

    Article  PubMed  Google Scholar 

  16. Oman JA, Cooper RJ, Holmes JF et al (2006) Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics 117:e238–246

    Article  PubMed  Google Scholar 

  17. Saboori M, Ahmadi J, Farajzadegan Z (2007) Indications for brain CT scan in patients with minor head injury. Clin Neurol Neurosurg 109:399–405

    Article  PubMed  Google Scholar 

  18. Greenes DS, Schutzman SA (1999) Clinical indicators of intracranial injury in head-injured infants. Pediatrics 104(4 Pt 1):861–867

    Article  CAS  PubMed  Google Scholar 

  19. Mogbo KI, Slovis TL, Canady AI et al (1998) Appropriate imaging in children with skull fractures and suspicion of abuse. Radiology 208:521–524

    CAS  PubMed  Google Scholar 

  20. Andronikou S, Kilborn T, Patel M et al (2003) Skull fracture as a herald of intracranial abnormality in children with mild head injury: is there a role for skull radiographs? Australas Radiol 47:381–385

    Article  PubMed  Google Scholar 

  21. Bonadio WA, Smith DS, Hillman S (1989) Clinical indicators of intracranial lesion on computed tomographic scan in children with parietal skull fracture. Am J Dis Child 143:194–196

    CAS  PubMed  Google Scholar 

  22. De Souza M, Moncure M, Lansford T et al (2007) Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less? J Trauma 63:370–372

    Article  PubMed  Google Scholar 

  23. Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR 176:289–296

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David B. Erlichman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erlichman, D.B., Blumfield, E., Rajpathak, S. et al. Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma. Pediatr Radiol 40, 1375–1379 (2010). https://doi.org/10.1007/s00247-010-1555-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-010-1555-4

Keywords

Navigation