Clinical indicators of intracranial lesion on computed tomographic scan in children with parietal skull fracture
W. A. Bonadio, D. S. Smith and S. Hillman
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53233.
We conducted a review of 98 cases of pediatric traumatic parietal skull
fracture in which computed tomographic (CT) scans of the head were obtained
during a seven-year period. There were 69 instances of an associated
intracranial lesion identified in 47 children, including parenchymal injury
(23), epidural hematoma (17), subdural hematoma (11), cerebral edema (ten),
and subarachnoid hemorrhage (eight). Compared with 51 other children with
parietal skull fracture and normal CT scans, the clinical characteristics
significantly associated with the presence of an intracranial lesion were
symptoms of neurologic dysfunction (loss or altered level of consciousness
and/or seizure activity), neurologic compromise on examination (altered
level of consciousness and/or focal deficit), or complicated skull fracture
(bilateral, diastatic, and/or depressed). Of the 47 children with an
intracranial lesion on CT scan, 44 had at least one of these significant
clinical characteristics (sensitivity, 93%; specificity, 50%;
positive-predictive value, 62%; and negative-predictive value, 96%).
Children who sustain traumatic parietal skull fracture commonly experience
associated intracranial injury. Those with evidence of neurologic deficit
or complicated skull fracture are at particularly high risk, and should
receive cranial CT scan evaluation.
