The significance of skull fracture in acute traumatic intracranial hematomas in adolescents: a prospective study

Abstract

A prospective study was conducted to validate the retrospective finding that adolescents (11 to 15 years old) with skull fractures were prone to develop acute traumatic intracranial hematoma (ICH). Over a 4-year period, 1178 consecutive adolescents attended the emergency room directly, of whom 760 were discharged well and 418 were admitted. All underwent skull x-ray studies. Immediate computerized tomography (CT) scans were performed in patients with Glasgow Coma Scale (GCS) scores of less than 15, in those with radiological and/or clinical evidence of skull fracture, and whenever clinically indicated. Of the 418 admitted patients, only 26 had skull fractures; 13 of these developed ICH. Four patients without skull fracture developed diffuse brain swelling. The remaining 401 patients were discharged after observation periods of up to 48 hours. Of the 13 patients with ICH, 10 had admission GCS scores of 15; however, four deteriorated rapidly and required urgent operation, and four remained stable but were operated on due to their large ICH. Two required conservative treatment only and both made good recovery. Three patients were in coma (GCS score less than or equal to 8) on admission. One patient had an epidural hematoma and made good recovery after surgery. Two developed delayed ICH after operations for associated systemic injuries despite initial CT showing diffuse brain swelling only, and both died despite evacuation of the ICH. Multivariate analysis showed that skull fracture was the only independent significant risk factor in predicting ICH in adolescents (sensitivity of 100% and specificity of 97%). A routine skull x-ray study is therefore mandatory in all head-injured adolescents and, if a skull fracture is detected, immediate CT may be performed for early detection of ICH.

A Prospective Study of Spectrum of Depressed Fractures of Skull and its Surgical Outcome

“…2 Cranial fracture is found to be the only independent significant risk factor in predicting intracranial hematomas. 11 In the present study, more than half of the patients had intracranial hematoma (extradural hematoma 50%, subdural hematoma 4.5%) (Fig. 5), which is lesser compared with the study done by Macpherson et al, 12 wherein 71% of the patients with cranial fracture had an intracranial lesion.…”

Two Different Approaches in Obtaining Head Computerized Tomography Scan in Minor Head Injuries

“…The separation between minor (GCS score of 15) and mild head injury (GCS score of 13 -14) is essential because the latter has significantly higher incidence of abnormal CT scan, the need for surgery and clinical deterioration [10][11][12][13][14][15]. Therefore, the use of initial CT scan in head injury with a GCS score of 13 and 14 is in agreement among investigators [4,10,11,16,17].…”

Hematoma epidural espontâneo: relato de dois casos

“…A presença de fratura de crânio nos HED é quase que obrigatória, principalmente quando se trata de adolescentes, sua incidência variando de 83 a 95% [2][3][4][5] . Quando frente a um HED sem história de traumatismo craniencefálico e ausência de fratura de crânio, podemos inferir que se trata de hematoma epidural espontâneo 5 .…”

“…Cerca de 83 a 95% dos casos estão associados a fraturas de crânio [2][3][4][5] ; porém, quando não há história ou sinais de traumatismo e na ausência de fraturas de crânio, pode-se dizer que o HED ocorreu espontaneamente 5 . Alguns casos de HED espontâneo têm sido relatados, associados a doenças infecciosas (sinusites e otite média aguda) [5][6][7][8][9][10][11] , malformações vasculares da dura-máter 5,12,13 , distúrbios da coagulação 14,15 e metástases na calota craniana 16 .…”