Appropriate imaging in children with skull fractures and suspicion of abuse.

PURPOSE

To define the role of computed tomography (CT) in children aged 2 years and younger with head trauma, suspected abuse, and normal neurologic findings.

MATERIALS AND METHODS

From 1992 through 1995, 87 consecutive children with skull fractures visible at plain radiography were referred to child protective services for evaluation of suspected abuse. Their cases were retrospectively reviewed.

RESULTS

Of 67 children with normal neurologic findings, 35 (52%) were not referred for CT. No patient in this group developed delayed findings requiring further evaluation. Of the 32 (48%) who underwent head CT, only six (19%) had evidence of acute intracranial injury, despite the presence of minimal depression and stellate, multiple, and diastatic fractures. Of 20 children with acute neurologic findings, 16 (80%) had positive CT scans, which led to neurosurgical intervention in nine (45%).

CONCLUSION

No child with normal neurologic findings had a clinically important abnormality depicted at CT. CT scans did not alter clinical management, clinical outcome, or legal outcome. Thus, routine CT of all patients with skull fractures in this population may be unnecessary.