Association between skull fractures and types of intracranial hematomas in children with head injury

Hemn Hasan Abdulrahim

doi:10.15218/zjms.2019.013

Authors

Hemn Hasan Abdulrahim Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq

DOI:

https://doi.org/10.15218/zjms.2019.013

Keywords:

Skull fracture, Intracranial hemorrhage, Head injury, Children

Abstract

Background and objective: Treating children with head injuries is one of the most frequent causes of admission to the neurosurgical emergency unit in Erbil city. In many cases, the parents ask whether the presence of a skull fracture in their child indicates any association with intracranial hemorrhage. Most of the previous studies focused on the association between skull fractures and intracranial hematomas in the adult population. We conducted this study to determine if there is a statistically significant association between skull fracture and types of intracranial hemorrhage in children.

Methods: A descriptive study was conducted between July 2015 and July 2017 at West Erbil Emergency Hospital. The study sample included children with the head injury whose brain Computerized Tomography (CT)-scan showed intracranial hemorrhage. Data collected using a questionnaire prepared by the researcher. Data were analyzed using descriptive and inferential statistical tests.

Results: A total of 201 children met the inclusion criteria; their ages ranged between 2 months and 17 years. Male to female ratio was 121:80. Highest percentages (64.7%) of children were 1-5 years old. The most common (72.63%) cause of head injury was fall from height. The most frequent (48.8%) intracranial hematoma encountered was an epidural hematoma, followed by intracerebral hematoma and subdural hematomas. There was a highly significant (P = 0.001) association between skull fractures and types of intracranial hematomas.

Conclusion: In children, skull fracture increases the incidence of intracranial hematoma. Most common intracranial hematomas in order of frequency were an epidural hematoma, intracerebral hematoma, and subdural hematoma. The most common cause of head injury was fall from height. Most patients were males between one and five years old.

Metrics

Metrics Loading ...

References

National Center for Injury Prevention and Control. Traumatic brain Injury in the United States: Assessing outcomes in children. Atlanta: Centers for Disease Control and Prevention; 2000.

Mann KS, Chan KH, Yue CP. Skull fractures in children: their assessment in relation to developmental skull changes and acute intracranial hematomas. Childs Nerv Syst 1986; 2:258–61.

Graham DI, Gennareli TA, McIntosh TK. Trauma. In: Graham DI, Lantos PL, editors. Greenfield’s Neuropathology. 7th ed. London: Arnold; 2002. P. 822–98.

Arrey EN, Marcia LK, Fletcher S, Cox CS, Sandberg DI. Linear nondisplaced skull fractures in children: who should be observed or admitted? J Neurosurg Pediatr 2015; 16:703–8.

Christopher MB, Sanjay N, Oluwaseun A. Pediatric Skull Fracture: the need for surgical intervention, characteristics, complications and outcomes. J Neurosurg Pediatr 2014; 14:205–11.

Orman G, Wagner M, Seeberg D, Zamora CA, Oshmyanski A, Tekes A, et al. Pediatric Skull Fracture Diagnosis: Should 3D reconstruction be added as a routine imaging? J Neurosurg Pediatrics 2015; 16:426–31.

Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 2006; 91:885–91.

Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med 2001; 37:65–74.

Saadat S, Rashidi N, Rasouli M. Pattern of skull fracture in Iran: Report of the Iran National Trauma Project. Turkish Journal of Trauma and Emergency Surgery 2011; 17(2):149–51.

White IK, Pestereva E, Shaikh KA. Transfer of children with isolated linear skull fractures: is it worth the cost? J Neurosurg Pediatr 2016; 17:602–6.

Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg 1968; 29:1–12.

Miller JD, Jennet WB. Complications of depressed skull fracture. Lancet 1968; 2:991.

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell WD, et al. Surgical management of acute subdural hematomas. Neurosurgery 2006; 58(3 Suppl):S16–24.

Miller J, Piper I, Jones P. Pathophysiology of head injury. In: Narayan RK, Willberger JE, Povlishock JT, eds: Neurotrauma. New York: McGraw-Hill; 1996. P. 61–9.

Chan K, Mann K, Yue CP. The significance of skull fracture in acute traumatic intracranial hematomas in adolescents: a prospective study. J Neurosurg 1990; 72:189–94.