title: Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma.
abstract: We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma.
  
  
  
  This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT).
  
  
  
  Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT.
  
  
  
  Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.
authors.affiliation: Departments of Emergency Medicine and Pediatrics, NYU School of Medicine, New York, NY. Electronic address: mt12@nyu.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
authors.affiliation: Division of Emergency Medicine, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Powell
authors.affiliation: Departments of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Jeff E
authors.initials: JE
authors.lastname: Schunk
authors.affiliation: Holy Cross Hospital, Silver Spring, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT; PECARN Data Coordinating Center, University of Utah, Salt Lake City, UT.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT; PECARN Data Coordinating Center, University of Utah, Salt Lake City, UT.
authors.forename: Sally Jo
authors.initials: SJ
authors.lastname: Zuspan
authors.affiliation: Department of Radiology, University of California, Davis School of Medicine, Davis, CA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wootton-Gorges
authors.affiliation: Division of Pediatric Emergency Medicine, Children's National Medical Center, George Washington School of Medicine, Washington, DC.
authors.forename: Shireen M
authors.initials: SM
authors.lastname: Atabaki
authors.affiliation: Department of Emergency Medicine, Michigan State University, Grand Rapid, MI; Departments of Emergency Medicine and Pediatrics, Western Michigan University School of Medicine, Kalamazoo, MI.
authors.forename: John D
authors.initials: JD
authors.lastname: Hoyle
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D020205:Skull Fracture, Basilar / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome