Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?
OBJECTIVE
To determine the clinical evolution of children with skull fractures as a result of a minor head trauma from a witnessed accidental fall that have been studied by transfontanellar ultrasound (TFUS).


METHODS
Observational study for 2 years (2004-2006) of children up to 1 year of age who suffered a skull fracture after minor head trauma and for whom a TFUS was carried out as the first neuroimaging test to rule out intracranial injuries.


RESULTS
One hundred and twenty-three children were evaluated. The mean age was 5.7 months (SD 2.9) and the most common mechanism of injury was rolling off the bed. In seven (5.7%) patients, a computed tomography (CT) was eventually performed after TFUS; in two of these patients, this was because of the detection of possible intracranial alterations and in the others, it was because of a small fontanelle. Both patients with abnormal TFUS had a small epidural haematoma on the CT scan that did not need surgery. The clinical course for all patients was uneventful.


CONCLUSIONS
TFUS is a valid and reliable alternative to CT for minor head trauma in infants with skull fractures. Its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation.
Department of Emergency Paediatrics, Sant Joan de Déu Hospital, University of Barcelona, Spain. vtrenchs@hsjdbcn.org
Victoria
V
Trenchs
Ana I
AI
Curcoy
Marta
M
Castillo
Josep
J
Badosa
Carles
C
Luaces
Jordi
J
Pou
Ramon
R
Navarro
D000058:Accidental Falls; D003362:Cost-Benefit Analysis; D055762:Cranial Fontanelles / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D015203:Reproducibility of Results; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging*; D013030:Spain; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000191:economics