title: Yield of skeletal surveys in children ≤ 18 months of age presenting with isolated skull fractures.
abstract: OBJECTIVE
  To measure the yield of a skeletal survey in children ≤ 18 months old presenting with isolated skull fractures without significant intracranial injury.
  
  
  METHODS
  A retrospective chart review was conducted on all children ≤ 18 months old presenting with an isolated skull fracture not associated with a motor vehicle crash or shopping cart fall between January 1, 2004 and December 31, 2010. An institutional protocol requires a skeletal survey and social work consult on all such children. We analyzed the association of mechanism of injury, type of skull fracture, and presence of "red flags" with a positive skeletal survey using χ(2) and Fisher exact tests.
  
  
  RESULTS
  Of 175 eligible patients, 150 (86%) underwent a skeletal survey. Of the 9 patients (6%) who had another fracture in addition to the presenting one, only 1 child was older than 6 months. Eight patients with additional fractures had a simple skull fracture (not complex) and 7 patients with other fractures had at least 1 red flag. Regarding skull fractures, the majority of long falls (81%) resulted in a simple skull fracture.
  
  
  CONCLUSIONS
  The skeletal survey in patients with isolated skull fractures revealed additional fractures in 6% of patients. Thus, a skeletal survey may yield clinically and forensically relevant data in such patients. However, it may be possible to restrict the window for obtaining a skeletal survey to younger infants, particularly those who are premobile.
authors: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Antoinette L
authors: AL
authors: Laskey
authors: Timothy E
authors: TE
authors: Stump
authors: Ralph A
authors: RA
authors: Hicks
authors: Jodi L
authors: JL
authors: Smith
mesh_terms: D002649:Child Abuse / Q000175:diagnosis; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis; D012189:Retrospective Studies; D012887:Skull Fractures / Q000175:diagnosis*