Citation

Deye KP, Berger RP, Lindberg DM. J. Trauma Acute Care Surg. 2013; 74(6): 1553-1558.

Affiliation

From the Freddie Mac Foundation Child and Adolescent Protection Center (K.P.D.),Children's National Medical Center, George Washington University School ofMedicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department ofEmergency Medicine (D.M.L.), Brigham and Women's Hospital; and Division of Emergency Medicine (D.M.L.), Children's Hospital Boston, Boston, Massachusetts.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e31828b7fc4

PMID

23694887

Abstract

BACKGROUND: There is currently no consensus about which screening studies should be undertaken to identify abusive injuries in infants with apparently isolated skull fractures. Our objective was to determine rates of screening, rates of injury identification, and rates of reporting to child protective services among infants who underwent subspecialty evaluation for abuse after presenting with an apparently isolated skull fracture. METHODS: This was a retrospectively planned, secondary analysis of index children enrolled in a large network of children with concerns for physical abuse. For this analysis, we included infants (<12 months) who presented with signs and symptoms attributable to a skull fracture. We determined rates of skeletal survey, dedicated ophthalmologic examination and abdominal injury screening, rates of injury identification by testing and reports to child protective services. RESULTS: A total of 215 infants underwent abuse consultation for apparently isolated skull fractures. Skeletal surveys were performed in 201 subjects (93.4%) and identified additional fractures in 12 (5.6%; 95% confidence interval, 2.9-9.6%). Patient age, trauma history, and fracture type (simple/complex) were not sensitive predictors of finding additional fractures on skeletal survey. Only one additional fracture was associated with clinical signs or symptoms. Dedicated ophthalmologic examination was undertaken in 100 subjects (46.5%); one child had retinal hemorrhages. Hepatic transaminases were obtained in 135 subjects (62.7%), and 5 subjects (2.3%) had abdominal computed tomography. No abdominal injuries were identified. A total of 146 subjects (67.9%) were reported to child protective services. CONCLUSION: Infants with apparently isolated skull fractures are an important fraction of consultations for physical abuse. Additional fractures are identified in a small subset of the skeletal surveys completed in these children. LEVEL OF EVIDENCE: Epidemiological study, level IV.

Language: en