Skull fracture (peds): Difference between revisions
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{{Peds top}} [[skull fracture]].'' | |||
==Background== | ==Background== | ||
[[File:Cranial bones en.png|thumb|Bones of the cranium.]] | |||
*Predictor of intracranial injury | |||
*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 | |||
== | ==Clinical Features== | ||
* | *Scalp hematoma | ||
* | *Skull tenderness | ||
* | *Skull depression or crepitus | ||
*Battle sign or raccoon eyes ([[basilar skull fracture]]) | |||
*Loss of consciousness, [[nausea and vomiting (peds)|nausea/vomiting]], [[altered mental status (peds)|altered mental status]] (less common in younger children than other children and adults with isolated skull fracture)<ref name="Powell" /> | |||
* | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Head trauma DDX}} | |||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
==Evaluation== | |||
*[[Head CT]] | |||
*Evaluate for additional injuries | |||
==Management== | ==Management== | ||
* | *Consider antibiotics for: | ||
**Open | **Open fracture | ||
**Depressed | **Depressed fracture | ||
** | **Sinus involvement | ||
** | **Pneumocephalus | ||
*[[Ceftriaxone]] | *[[Ceftriaxone]] '''AND''' [[metronidazole]] +/- [[vancomycin]] | ||
==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><ref name="Powell" />: | |||
**Neurologically normal | |||
**Isolated closed linear skull fracture | |||
**No concern for [[non-accidental trauma]] | |||
*Admit all others | |||
==See Also== | ==See Also== | ||
*[[Head Trauma]] | *[[Head Trauma]] | ||
*[[Skull fracture]] (Adult) | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Neurology]] | ||
Latest revision as of 20:50, 11 November 2020
This page is for pediatric patients. For adult patients, see: skull fracture.
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 (basilar 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
- Evaluate for additional injuries
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.