Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT.
Department of Radiology.
Pediatr Emerg Care. 2022 Jan 1;38(1):e200-e204. doi: 10.1097/PEC.0000000000002214.
The aim of the study was to determine whether complex skull fractures are more indicative of child abuse or major trauma than simple skull fractures.
This is a retrospective chart and imaging review of children diagnosed with a skull fracture. Subjects were from 2 pediatric tertiary care centers. Children younger than 4 years who underwent a head computed tomography with 3-dimensional rendering were included. We reviewed the medical records and imaging for type of skull fracture, abuse findings, and reported mechanism of injury. A complex skull fracture was defined as multiple fractures of a single skull bone, fractures of more than 1 skull bone, a nonlinear fracture, or diastasis of greater than 3 mm. Abuse versus accident was determined at the time of the initial evaluation with child abuse physician team confirmation.
From 2011 to 2012, 287 subjects were identified by International Classification of Diseases, Ninth Revision, code. The 147 subjects with a cranial vault fracture and available 3-dimensional computed tomography composed this study's subjects. The average age was 12.3 months. Seventy four (50.3%) had complex and 73 (49.7%) had simple fractures. Abuse was determined in 6 subjects (4.1%), and a determination could not be made for 5 subjects. Adding abused children from 2013 to 2014 yielded 15 abused subjects. Twelve of the abused children (80%) had complex fractures; more than the 66 (48.5%) of 136 accidentally injured children (P = 0.001; relative risk = 1.65 [1.21-2.24]). However, among children with a complex fracture, the positive predictive value for abuse was only 7%.
Complex skull fractures frequently occur from accidental injuries. This study suggests that the presence of complex skull fractures should not be used alone when making a determination of abuse.
本研究旨在确定复杂颅骨骨折是否比单纯颅骨骨折更能提示虐待儿童或严重外伤。
这是一项对诊断为颅骨骨折的儿童进行回顾性图表和影像学检查的研究。研究对象来自 2 家儿科三级护理中心。研究纳入了年龄小于 4 岁且接受过头颅 CT 三维成像检查的患儿。我们回顾了病历和影像学资料，记录颅骨骨折类型、虐待相关发现以及报告的损伤机制。复杂颅骨骨折定义为单个颅骨多处骨折、多个颅骨骨折、非直线形骨折或骨缝分离超过 3 毫米。最初评估时由儿童虐待医生团队确定损伤是意外还是虐待所致，同时进行确认。
2011 年至 2012 年，根据国际疾病分类，第九版代码，共确定了 287 名患儿。本研究共纳入了 147 名颅骨穹窿骨折且有三维 CT 检查结果的患儿。患儿的平均年龄为 12.3 个月。74 名（50.3%）患儿为复杂颅骨骨折，73 名（49.7%）患儿为单纯颅骨骨折。6 名（4.1%）患儿被确定为虐待，5 名患儿无法确定。将 2013 年至 2014 年的虐待患儿纳入后，共纳入 15 名虐待患儿。12 名（80%）虐待患儿为复杂颅骨骨折，多于 136 名（48.5%）意外受伤患儿（P=0.001；相对危险度=1.65[1.21-2.24]）。然而，在有复杂颅骨骨折的患儿中，虐待的阳性预测值仅为 7%。
复杂颅骨骨折常由意外损伤引起。本研究表明，在判断是否为虐待所致时，不应仅依据是否存在复杂颅骨骨折。
