Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management

Abstract

Introduction: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays.

Material and methods: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period.

Results: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery.

Conclusion: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria.

Keywords: Computed tomography; Fractura lineal; Linear fracture; Mild traumatic brain injury; Pediatrics; Pediatría; Tomografía computarizada; Traumatismo craneoencefálico leve.