Skull fracture (peds)
This page is for pediatric patients; for adult patients see skull fracture
Background
Bones of the cranium.
- Predictor of intracranial injury
- Infants are at higher risk due to thinner calvarium (median age for isolated skull fracture is 10 months)[1]
- Most skull fractures have overlying hematoma
Clinical Features
- Scalp hematoma
- Skull tenderness
- Skull depression or crepitus
- Battle sign or raccoon eyes (basilar skull fracture)
- Loss of consciousness, nausea/vomiting, altered mental status (less common in younger children than other children and adults with isolated skull fracture)[1]
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Skull fracture
- Pediatric head trauma
Evaluation
- Head CT
- Evaluate for additional injuries
Management
- Consider antibiotics for:
- Open fracture
- Depressed fracture
- Sinus involvement
- Pneumocephalus
- Ceftriaxone AND metronidazole +/- vancomycin
Disposition
- Consider discharge if[2][1]:
- Neurologically normal
- Isolated closed linear skull fracture
- No concern for non-accidental trauma
- Admit all others
See Also
- Head Trauma
- Skull fracture (Adult)
External Links
References
- Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858
- Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.
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