When Its Just a Bump on the Head: Interpreting Skull Fractures in the Context of Child Maltreatment
- Infants with apparently isolated skull fractures are an important fraction of consultations for physical abuse. Additional fractures are identified in a small subset of the skeletal surveys completed in these children.*
- The skeletal survey in patients with isolated skull fractures revealed additional fractures in 6% of patients.**
REFERENCES:
- Deye, Berger & Lindberg 2013
- Laskey et al 2013
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What I usually ask clinicians grappling with the question of whether to get a skeletal survey in these situations is, if the skeletal survey is negative does it make you more confident that the identified skull fracture is not from abuse? Similar to the isolated small bruise on the torso of a young child, the clinician needs to decide whether the index injury is concerning for abuse and if so, then a skeletal survey is warranted. If it isn’t concerning in and of itself, then I would suggest that we need to ask ourselves what’s the purpose of doing the skeletal survey looking for occult fractures of abuse?
