Jacobs Journal of Emergency Medicine

Suspected Skull Fractures: Are Radiographic Examinations Necessary in Children Who Appear Well?

Published on: 2019-04-01


Introduction: Children with isolated skull fractures (SF) diagnosed with a computed tomography (CT) scan do not require hospitaliza- tion if they are neurologically normal. The aim of this study was to assess whether CT scans are necessary to confirm a suspected SF or whether children appearing well can be managed as outpatients without radiographic examinations.
Methods: This retrospective study analyzed data from children up to 16 years with a radiographically confirmed SF in 2014 and 2015. The variables analyzed included demographic data, the child’s general condition, the Glasgow Coma Scale (GCS), the management of radiographic examinations and observations, and the necessity of a neurosurgical intervention.
Results: A total of 68 patients were analyzed; their mean age was 3 years (range 4 days – 15 years), and most fractures were diagnosed with skull radiographs (60.3%; 41/68), followed by CT scans (36.7%; 25/68). Fifty-five children (80.9%) appeared well with a GCS of 15, although in two infants, intracranial hematomas were found with no need for intervention. In contrast to children with GCSs of 13 and 14, four of six had intracranial injuries, two of whom required neurosurgical interventions.
Discussion: When a SF is suspected, children older than one year who appear well with a GCS of 15 and a normal neuro- logical exam result might be managed safely as outpatients if parents are reliable and understand return-for-care criteria. In these cases, a radiographic confirmation of the clinically suspected SF does not seem necessary for acute management.


Skull fractures; Brain injury; Mild head trauma; Computed tomography