Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA, USA.
Eur J Pediatr. 2024 Dec;183(12):5321-5330. doi: 10.1007/s00431-024-05807-w. Epub 2024 Oct 10.
To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children < 18 years old with Glasgow Coma Scale scores ≥ 14 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368/10,698 (3.4%) children < 2 years old, and in 676/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56/273 (20.5%) of younger children with palpable skull fractures and in 34/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6-24.2%), and in 30/486 (6.2%) vs 63/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5-7.8%). TBIs on CT were found in 73/273 (26.7%) and 189/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2-25.9), and in 61/486 (12.6%) vs 424/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1-12.0).Conclusions: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.
评估儿童在因轻微头部创伤后体格检查时发现有可触及颅骨骨折与无可触及颅骨骨折时，计算机断层扫描（CT）上是否存在实际的凹陷性颅骨骨折和创伤性脑损伤（TBI）。这是一项对前瞻性、观察性多中心研究的二次分析，共纳入 42412 名格拉斯哥昏迷量表评分≥14 分的 18 岁以下钝性头部创伤患儿。可触及颅骨骨折是根据治疗医生在病例报告表上的记录来定义的。颅骨骨折和 TBI 是由现场放射科医生在 CT 扫描上确定的。在<2 岁的儿童中，368/10698（3.4%）有可触及颅骨骨折，而在年龄较大的儿童中，676/31613（2.1%）有可触及颅骨骨折。在有可触及颅骨骨折的 273 名儿童中，56 名（20.5%）有凹陷性颅骨骨折，而在无可触及颅骨骨折的 3047 名儿童中，34 名（1.1%）有凹陷性颅骨骨折（发生率差异 19.4%；95%CI 14.6-24.2%），在年龄较小的儿童中，30/486（6.2%）vs 63/11130（0.6%）有 TBI（发生率差异 5.6%；95%CI 3.5-7.8%）。在有可触及颅骨骨折的 273 名儿童中，73 名（26.7%）有 TBI，而在无可触及颅骨骨折的 3047 名儿童中，189 名（6.2%）有 TBI（发生率差异 20.5%；95%CI 15.2-25.9%），在年龄较大的儿童中，61/486（12.6%）vs 424/11130（3.8%）有 TBI（发生率差异 8.7%；95%CI 6.1-12.0%）。结论：尽管 CT 上有凹陷性颅骨骨折和 TBI 的儿童比无凹陷性颅骨骨折的儿童更常见，但这些儿童中大多数并无实际的凹陷性骨折。通过直接在床边对颅骨进行可视化，例如通过超声检查，可提高头皮检查的鉴别能力。
