Arneitz Christoph, Sinzig Maria, Fasching Günter
Department of Paediatric and Adolescent Surgery, Clinical Centre Klagenfurt, Klagenfurt, Austria.
Department of Radiology, Section of Paediatric Radiology, Clinical Centre Klagenfurt, Klagenfurt, Austria.
J Clin Imaging Sci. 2016 Nov 16;6:47. doi: 10.4103/2156-7514.194261. eCollection 2016.
The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma.
We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period.
In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days.
Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.
轻度头部外伤后常规颅骨X线检查的指征仍存在争议，颅骨骨折患儿的临床管理也颇具争议。我们这项回顾性研究的目的是评估我院对轻度头部外伤后颅骨骨折患儿的诊断及临床管理情况。
我们梳理了2009年1月至2014年10月期间在我院接受治疗的所有连续性颅骨骨折患者的病史，并调查了在此期间我院所有的颅骨X线检查。
在5217次颅骨X线检查中，检测到66例颅骨骨折（1.3%）。所有患者的平均年龄为5.9岁（中位年龄：4.0岁）；确诊颅骨骨折患者的平均年龄为2.3岁（中位年龄：0.8岁）。共有1658名儿童（32%）年龄小于2岁。61%的颅骨骨折患者出现典型的头皮下血肿。大多数损伤是由跌倒所致（77%）。9名患者（14%）因神经症状在住院期间需要进行计算机断层扫描（CT），4名患者进行了脑磁共振成像检查。9名患者（14%）出现颅内出血（平均年龄：7.3岁）；1名患者因颅骨凹陷性骨折接受了神经外科手术。9名患者（14%）在我院儿科重症监护病房接受观察，平均观察时间为2.9天。平均住院时间为4.2天。
我们的研究结果支持既往反对常规使用颅骨X线检查评估轻度头部外伤患儿的证据。轻度头部外伤后X线检查中确诊颅骨骨折的比例较低，对于无症状的线性颅骨骨折患者无需额外进行CT扫描。所有检测到的颅内出血均可保守治疗。2岁以下儿童在轻度头部外伤后发生颅骨骨折的风险最高，但颅内出血发生率并未更高。对于轻度头部外伤后的婴幼儿及儿童，不进行初始CT扫描而进行神经观察是安全的，CT扫描应仅用于有神经症状的患者。
