Introduction: Skull fractures are the most common type of fracture in infancy; while most are not due to abuse, they are the second most common fracture attributable to abuse. Most infant skull fractures are single parietal skull fractures, and some studies have found that, in comparison, occipital fractures and multiple skull fractures are more likely to be caused by higher energy trauma, involve more intracranial injury, and are more often caused by physical abuse. We hypothesized that, compared to infants with single parietal skull fractures, infants with occipital fracture(s) and multiple skull fractures (in any location) are more likely to: 1. Have findings associated with physical abuse (social risk factors and additional injuries (extra-cranial fractures, cutaneous injuries, and intracranial injuries)). 2. Have higher energy trauma histories (greater fall distance, involvement of other people/objects in fall). Methods: This was a retrospective study of infants under 12 months of age who presented to a tertiary care children’s hospital and were diagnosed with a skull fracture via head CT. Detailed information about demographics, trauma histories, symptoms, injuries, and social risk factors was obtained. A neuroradiologist reviewed all neuroimaging, documenting fracture features and intracranial injuries. The characteristics of children with single parietal skull fractures were compared to those from children with occipital fracture(s) and multiple skull fractures through chi-square and Wilcoxon rank sum tests as appropriate to scale. Results: Of the 280 infants in our study, 190 (68%) had isolated parietal fractures, 38 (14%) had isolated occipital fracture(s), and 62 (22%) had multiple skull fractures (which included parietal, occipital, frontal and temporal fractures). There were no differences in social risk factors between groups (Table 1). Extra-cranial fractures and cutaneous injuries also did not differ. Intracranial injuries were more common with multiple skull fractures (subdural hematomas (p=.04), subarachnoid/subpial hemorrhage (p=.03), parenchymal injuries (p<.01). Infants with multiple and occipital fractures were more likely to have fallen over 3 feet or have fallen down stairs (p=.01, p=.03), and infants with occipital fractures were more likely to have falls involving another person or object (p=.007) (Table 2). The determination of abuse was more common in infants with multiple fractures (p<.01) (Table 1). Conclusions: While a diagnosis of physical abuse and intracranial injuries were more common in children with multiple skull fractures, they were not more common in children with occipital fractures. Neither multiple nor occipital fractures were associated with higher rates of extra-cranial injuries or social risk factors.
Single parietal skull fractures versus occipital fractures and multiple fractures in infants: are there differences in history, findings, and determination of abuse?
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Amanda K. Fingarson, Maura Ryan, Elizabeth Charleston, Douglas Lorenz; Single parietal skull fractures versus occipital fractures and multiple fractures in infants: are there differences in history, findings, and determination of abuse?. Pediatrics July 2020; 146 (1_MeetingAbstract): 2–3. 10.1542/peds.146.1MA1.2b
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