Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children.
Children
Emergency medicine
Head trauma
Skull fracture
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
10 Oct 2024
10 Oct 2024
Historique:
received:
06
08
2024
accepted:
29
09
2024
revised:
20
09
2024
medline:
13
10
2024
pubmed:
13
10
2024
entrez:
10
10
2024
Statut:
aheadofprint
Résumé
To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children < 18 years old with Glasgow Coma Scale scores ≥ 14 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368/10,698 (3.4%) children < 2 years old, and in 676/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56/273 (20.5%) of younger children with palpable skull fractures and in 34/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6-24.2%), and in 30/486 (6.2%) vs 63/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5-7.8%). TBIs on CT were found in 73/273 (26.7%) and 189/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2-25.9), and in 61/486 (12.6%) vs 424/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1-12.0).Conclusions: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.
Identifiants
pubmed: 39387905
doi: 10.1007/s00431-024-05807-w
pii: 10.1007/s00431-024-05807-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Arneitz C, Sinzig M, Fasching G (2016) Diagnostic and clinical management of skull fractures in children. J Clin Imaging Sci 6:47
doi: 10.4103/2156-7514.194261
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R et al (2009) Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374:1160–70
doi: 10.1016/S0140-6736(09)61558-0
Bressan S, Eapen N, Phillips N, Gilhotra Y, Kochar A, Dalton S et al (2021) Paediatric Research in Emergency Departments International Collaborative (PREDICT). PECARN algorithms for minor head trauma: risk stratification estimates from a prospective PREDICT cohort study. Acad Emerg Med 28:1124–1133
doi: 10.1111/acem.14308
Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K (2006) Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91:885–891
doi: 10.1136/adc.2005.083980
Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G et al (2010) CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 182:341–348
doi: 10.1503/cmaj.091421
Gorelick MH, Atabaki SM, Hoyle J, Dayan PS, Holmes JF, Holubkov R et al (2008) Pediatric Emergency Care Applied Research Network. Interobserver agreement in assessment of clinical variables in children with blunt head trauma. Acad Emerg Med 15:812–8
doi: 10.1111/j.1553-2712.2008.00206.x
Parri N, Crosby BJ, Mills L, Soucy Z, Musolino AM, Da Dalt L et al (2018) Point-of-care ultrasound for the diagnosis of skull fractures in children younger than two years of age. J Pediatr 196:230–236
doi: 10.1016/j.jpeds.2017.12.057
Alexandridis G, Verschuuren EW, Rosendaal AV, Kanhai DA (2022) Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis. Emerg Med J 39:30–36
doi: 10.1136/emermed-2020-209887
Gordon I, Sinert R, Chao J (2021) The utility of ultrasound in detecting skull fractures after pediatric blunt head trauma: systematic review and meta- analysis. Pediatr Emerg Care 37:e1701–e1707
doi: 10.1097/PEC.0000000000001958
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457
doi: 10.1016/S0140-6736(07)61602-X
Agresti A, Caffo B (2000) Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures. Am Stat 54:280–288
doi: 10.1080/00031305.2000.10474560
Figaji AA (2017) Anatomical and physiological differences between children and adults relevant to traumatic brain injury and the implications for clinical assessment and care. Front Neurol 8:685
doi: 10.3389/fneur.2017.00685
Akie TE, Gupta M, Rodriguez RM, Hendey GW, Wilson JL, Quinones AK, Mower WR (2023) Physical examination sensitivity for skull fracture in pediatric patients with blunt head trauma: a secondary analysis of the national emergency X-radiography utilization study II head computed tomography validation study. Ann Emerg Med 81:334–342
doi: 10.1016/j.annemergmed.2022.08.442
Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M et al (2017) Paediatric Research in Emergency Departments International Collaborative (PREDICT). Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet 389:2393–2402
doi: 10.1016/S0140-6736(17)30555-X
Cicogna A, Minca G, Posocco F, Corno F, Basile C, Da Dalt L et al (2022) Non-ionizing imaging for the emergency department assessment of pediatric minor head trauma. Front Pediatr 10:881461
doi: 10.3389/fped.2022.881461
Peter C, Stranzinger E, Heverhagen JT, Keitel K, Romano F, Busch JD, Slavova N (2023) Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists? Eur J Pediatr 182:3113–3120
doi: 10.1007/s00431-023-04939-9
Quayle KS, Jaffe DM, Kuppermann N, Kaufman BA, Lee BC, Park TS et al (1997) Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics 99:e11
doi: 10.1542/peds.99.5.e11
Lloyd DA, Carty H, Patterson M, Butcher CK, Roe D (1997) Predictive value of skull radiography for intracranial injury in children with blunt head injury. Lancet 349:821–824
doi: 10.1016/S0140-6736(96)09356-7
Hofman PA, Nelemans P, Kemerink GJ, Wilmink JT (2000) Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry 68:416–422
doi: 10.1136/jnnp.68.4.416
Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C et al (2004) A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 89:653–659
doi: 10.1136/adc.2003.027722
Greenes DS, Schutzman SA (1999) Clinical indicators of intracranial injury in head-injured infants. Pediatrics 104:861–867
doi: 10.1542/peds.104.4.861
Greenes DS, Schutzman SA (1998) Occult intracranial injury in infants. Ann Emerg Med 32:680–686
doi: 10.1016/S0196-0644(98)70067-8
Greenes DS, Schutzman SA (2001) Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care 17:88–92
doi: 10.1097/00006565-200104000-00002
Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D et al (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107:983–993
doi: 10.1542/peds.107.5.983
Bressan S, Marchetto L, Lyons TW, Monuteaux MC, Freedman SB, Da Dalt L et al (2018) A systematic review and meta-analysis of the management and outcomes of isolated skull fractures in children. Ann Emerg Med 71:714–724
doi: 10.1016/j.annemergmed.2017.10.014
Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T et al (2015) Isolated linear skull fractures in children with blunt head trauma. Pediatrics 135:e851–e857
doi: 10.1542/peds.2014-2858
Magana JN, Kuppermann N (2017) The PECARN TBI rules do not apply to abusive head trauma. Acad Emerg Med 24:382–384
doi: 10.1111/acem.13155