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


===Pediatric===
==Clinical Features==
*fractures are predictors of intracranial injury
*Scalp hematoma
*infants higher risk for fracture since thinner bones
*Skull tenderness
*most fractures have hematomas
*Skull depression or crepitus
 
*Battle sign or raccoon eyes ([[basilar skull fracture]])
==Diagnosis==
*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" />
*All skull fracture require [[Head CT]]
**
<gallery>
File:Skull_fracture.JPG| Depressed open skull fracture in a 5 yo M.
</gallery>


==Differential Diagnosis==
==Differential Diagnosis==
{{Head trauma DDX}}
{{Maxillofacial trauma DDX}}
{{Maxillofacial trauma DDX}}
==Evaluation==
*[[Head CT]]
*Evaluate for additional injuries


==Management==
==Management==
*Antibiotics indicated for:
*Consider antibiotics for:
**Open fracture
**Open fracture
**Depressed fracture
**Depressed fracture
**Involves sinus
**Sinus involvement
**Leads to pneumocephalus
**Pneumocephalus
*[[Ceftriaxone]] 2gm IV + [[metronidazole]] 500mg +/- [[vancomycin]] 1gm IV
*[[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:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Neurology]]
[[Category:Neurology]]

Latest revision as of 20:50, 11 November 2020

This page is for pediatric patients. For adult patients, see: skull fracture.

Background

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)[1]
  • Most skull fractures have overlying hematoma

Clinical Features

Differential Diagnosis

Head trauma

Maxillofacial Trauma

Evaluation

  • Head CT
  • Evaluate for additional injuries

Management

Disposition

  • Consider discharge if[2][1]:
  • Admit all others

See Also

External Links

References

  1. 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
  2. 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.