ISOLATED TRAUMATIC SKULL FRACTURES IN THE PEDIATRIC POPULATION - - PowerPoint PPT Presentation

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isolated traumatic skull fractures in the pediatric
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ISOLATED TRAUMATIC SKULL FRACTURES IN THE PEDIATRIC POPULATION - - PowerPoint PPT Presentation

Apr 24, 2023 869 likes •1.01k views

ISOLATED TRAUMATIC SKULL FRACTURES IN THE PEDIATRIC POPULATION Jonathan F. Bean, MD Rashmi S. Kabre, MD Catherine J. Hunter, MD Division of Pediatric Surgery, Department of Surgery Ann & Robert H. Lurie Childrens Hospital Chicago,

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ISOLATED TRAUMATIC SKULL FRACTURES IN THE PEDIATRIC POPULATION

Jonathan F. Bean, MD Rashmi S. Kabre, MD Catherine J. Hunter, MD

Division of Pediatric Surgery, Department of Surgery Ann & Robert H. Lurie Children’s Hospital Chicago, Illinois, USA

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SLIDE 2

Disclosures

  • No financial disclosures
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SLIDE 3

Introduction

  • Blunt head injury accounts for the majority of pediatric

trauma in the United States

  • Although a majority of patients with skull fractures will

have associated intracranial pathology, a fraction of these patients have a normal physical examination and an isolated skull fracture on head CT

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SLIDE 4

Skull Fracture

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SLIDE 5

Skull Fracture

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Hypothesis

  • There is a paucity of evidence to guide the management
  • f blunt trauma patients with an isolated skull fracture

without intracranial hemorrhage

  • We hypothesized that neurologic decline is rare in

patients with an isolated skull fracture from blunt head trauma and repeat imaging usually is unnecessary

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Materials and Methods

  • Single center retrospective review
  • Inclusion criteria
  • Blunt trauma
  • Isolated skull fracture on head CT
  • Normal neurological examinations
  • Exclusion criteria
  • Intracranial hemorrhage
  • Penetrating trauma
  • Depressed skull fractures or skull base involvement
  • Pneumocephalus
  • Poly-trauma or concern for non-accidental trauma
  • June 2004 to June 2014
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Results

  • 71 patients
  • 16 patients (22.5%) were discharged from the emergency

department

  • 55 patients (77.5%) were admitted for inpatient
  • bservation and serial neurologic examinations
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SLIDE 9

Results

Male 56% Female 44%

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SLIDE 10

Results: Age Distribution

5 10 15 20 25 30 < 6 months 6 months - 1 year 1 - 3 years 3 - 5 years 5 - 7 years 7 - 9 years 9 - 11 years 11 - 13 years > 13 years

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Results

  • 0 patients needed neurosurgical intervention in either

group

  • 4.2% of patients underwent repeat imaging
  • No association between age and repeat imaging

(p = 0.7474)

  • No association between age and inpatient observation

(p = 0.4074)

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Conclusions

  • An isolated traumatic skull fracture in a patient with

normal neurologic examination has a very low likelihood

  • f needing neurosurgical intervention
  • An isolated skull fracture is not necessarily an indication

for admission and neurologic observation

  • Further studies are needed to determine the indications

for inpatient observation in pediatric blunt head trauma patients

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SLIDE 13

Thank You!