From the Department of Radiology, Norton Children's Hospital, Louisville KY.
Pediatr Emerg Care. 2022 Feb 1;38(2):e703-e708. doi: 10.1097/PEC.0000000000002461.
Pediatric skull fracture association with the cranial sutures (crossing, widening, or contacting 2 or more cranial sutures) is suggestive of abusive injury. We studied the efficacy of head computed tomography (CT) versus skull radiographs in identifying pediatric skull fracture association with cranial sutures and reviewed head CT literature recommendations for pediatric head trauma.
Retrospective review was performed of skull radiographs and head CT at a tertiary care, free-standing children's hospital (2012-2019). Statistical 2-proportion Z test determined efficacy of head CT versus skull radiographs in assessing cranial suture involvement with fractures.
Forty-seven children with 56 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated, ages 1 to 36 months. Of the 110 total skull fractures evaluated, 51 abusive and 41 accidental skull fractures had terminal ends contacting cranial sutures for a total of 92 (84%). Twelve abusive fractures (24%) crossed sutures; no accidental fractures crossed sutures (P < 0.01). Of the 12 abusive cases with skull fractures that crossed sutures, 7 were definitively identified only on CT (P < 0.01). Widened sutures were documented in 4 (8%) of the abusive cases with skull fracture; none in the accidental cases. All 4 of these cases were equally identified on both skull radiography and CT imaging. In 21 of 47 abusive versus 5 of 47 accidental cases, CT identified skull fractures lines that extended to cranial sutures that were not definitive on skull radiography (P = 0.00022).
Cranial suture involvement with pediatric skull fractures is common. Head CT significantly aided in the identification of skull fractures contacting and crossing cranial sutures in abusive cases, supporting eliminating concurrent skull radiographs.
小儿颅骨骨折与颅缝（交叉、增宽或触及 2 条或以上颅缝）的关系提示为外伤性损伤。我们研究了头部 CT 与颅骨 X 线摄影在识别与颅缝相关的小儿颅骨骨折方面的效果，并回顾了儿童头部创伤的头部 CT 文献推荐。
对一家三级保健、独立儿童医院（2012-2019 年）的颅骨 X 线摄影和头部 CT 进行回顾性分析。统计 2 比例 Z 检验确定了头部 CT 与颅骨 X 线摄影在评估颅骨缝骨折受累方面的效果。
共评估了 47 例患有 56 例虐待性颅骨骨折和 47 例意外性颅骨骨折的 1 至 36 个月大的儿童。在评估的 110 例总颅骨骨折中，51 例虐待性和 41 例意外性颅骨骨折的末端接触颅缝，共 92 例（84%）。12 例虐待性骨折（24%）交叉了颅缝；无意外性骨折交叉了颅缝（P < 0.01）。在 12 例有颅骨骨折的虐待性病例中，有 7 例仅在 CT 上明确识别（P < 0.01）。4 例（8%）有颅骨骨折的虐待性病例记录了增宽的颅缝；无意外性病例。这 4 例在颅骨 X 线摄影和 CT 成像上均能明确识别。在 47 例虐待性病例中的 21 例和 47 例意外性病例中的 5 例中，CT 识别出颅骨骨折线延伸至颅骨 X 线摄影不能明确的颅缝（P = 0.00022）。
小儿颅骨骨折与颅缝的关系很常见。头部 CT 显著有助于识别虐待性病例中与颅缝接触和交叉的颅骨骨折，支持消除同时进行颅骨 X 线摄影。
