Department of Radiology, Norton Children's Hospital, 231 Chestnut St, Louisville, KY 40202.
AJR Am J Roentgenol. 2021 Jul;217(1):218-222. doi: 10.2214/AJR.20.23081. Epub 2021 Apr 28.
The purpose of this study was to assess the incidence of pediatric skull fractures contacting cranial sutures in abusive versus accidental trauma. A retrospective review was conducted of head CT studies performed for pediatric head trauma at a free-standing tertiary care children's hospital from 2012 to 2019. Statistical odds ratios were evaluated to assess the significance of skull fracture extension to sutures in abusive versus accidental injury. A two-proportion -test was used to determine the statistical significance of suture type contacted by skull fractures in accidental versus abusive injury. The records of 47 children with 57 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated. The patients were 1-36 months old. Fifty-one abusive skull fractures (89%) terminated in contact with a cranial suture; 35 of the 51 (69%) touched two or more sutures, and 12 touched three or more sutures. Forty-two of the 54 (78%) accidental skull fractures contacted a suture; only 3 of the 42 (7%) touched two sutures, and none touched more than two sutures (odds ratio, 28.4 [95% CI, 7.6-105.9]; < .001). In the abusive fractures, the suture most commonly contacted by a fracture line was the lambdoid (43%; < .04), followed by the sagittal (23%), coronal (21%), temporal-squamous (12%), and metopic (1%) sutures. There was no statistical difference in which suture was contacted by fracture lines in accidental cases. Skull fracture contacting cranial sutures is common in abusive and accidental pediatric head trauma. However, that a fracture contacts two or more cranial sutures is an imaging finding not previously described that has a significantly higher association with abusive than with accidental head injury.
本研究旨在评估虐待性与意外性创伤导致儿童颅骨骨折累及颅缝的发生率。对一家独立的三级儿童保健医院 2012 年至 2019 年期间因儿童头部创伤进行的头部 CT 研究进行了回顾性分析。评估了统计优势比，以评估颅骨骨折延伸至虐待性与意外性损伤时的颅缝的意义。采用两样本比例检验来确定颅骨骨折在意外性与虐待性损伤中累及的缝类型的统计学显著性。评估了 47 例患有 57 例虐待性颅骨骨折和 47 例患有 54 例意外性颅骨骨折患儿的记录。患儿年龄为 1-36 个月。51 例虐待性颅骨骨折（89%）与颅缝接触终止；51 例中有 35 例（69%）触及两个或更多缝，12 例触及三个或更多缝。54 例意外性颅骨骨折中有 42 例触及缝；42 例中有 3 例（7%）触及两个缝，无一例触及两个以上缝（比值比，28.4[95%CI，7.6-105.9]； <.001）。在虐待性骨折中，骨折线最常触及的缝是人字缝（43%； <.04），其次是矢状缝（23%）、冠状缝（21%）、颞鳞缝（12%）和额状缝（1%）。在意外情况下，骨折线触及的缝没有统计学差异。颅骨骨折累及颅缝在虐待性和意外性儿童头部创伤中很常见。然而，骨折线触及两个或更多颅缝是一种以前未描述过的影像学发现，与虐待性头部损伤的相关性明显高于意外性头部损伤。
