Skull fracture (peds): Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Predictor of intracranial injury | *Predictor of intracranial injury | ||
*Infants are at higher risk due to thinner calvarium | *Infants are at higher risk due to thinner calvarium (median age for isolated skull fracture is 10 months)<ref name="Powell">Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858</ref> | ||
*Most skull fractures have overlying hematoma | *Most skull fractures have overlying hematoma | ||
| Line 9: | Line 9: | ||
*Skull depression or crepitus | *Skull depression or crepitus | ||
*Battle sign or raccoon eyes (basal skull fracture) | *Battle sign or raccoon eyes (basal skull fracture) | ||
*Loss of consciousness, nausea/vomiting, altered mental status (less common in younger children than other children and adults with isolated skull fracture)<ref name="Powell" /> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 26: | Line 27: | ||
==Disposition== | ==Disposition== | ||
*Consider discharge if<ref>Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.</ref>: | *Consider discharge if<ref>Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.</ref><ref name="Powell" />: | ||
**Neurologically normal | **Neurologically normal | ||
**Isolated closed linear skull fracture | **Isolated closed linear skull fracture | ||
Revision as of 07:34, 8 February 2019
Background
- Predictor of intracranial injury
- Infants are at higher risk due to thinner calvarium (median age for isolated skull fracture is 10 months)[1]
- Most skull fractures have overlying hematoma
Clinical Features
- Scalp hematoma
- Skull tenderness
- Skull depression or crepitus
- Battle sign or raccoon eyes (basal skull fracture)
- Loss of consciousness, nausea/vomiting, altered mental status (less common in younger children than other children and adults with isolated skull fracture)[1]
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Intracranial hemorrhage
- Intra-axial
- Extra-axial
- Moderate-to-severe traumatic brain injury
- Mild traumatic brain injury
- Intracranial hemorrhage
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Head CT
Management
- Consider antibiotics for:
- Open fracture
- Depressed fracture
- Sinus involvement
- Pneumocephalus
- Ceftriaxone AND metronidazole +/- vancomycin
Disposition
- Consider discharge if[2][1]:
- Neurologically normal
- Isolated closed linear skull fracture
- No concern for non-accidental trauma
- Admit all others
See Also
- Head Trauma
- Skull fracture (Adult)
External Links
References
- ↑ 1.0 1.1 1.2 Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858
- ↑ Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.