Natural history and clinical implications of nondepressed skull fracture in young children

Saif F. Hassan, Stephen M. Cohn, John Admire, Olliver Nunez-Cantu, Yousef Arar, John G. Myers, Daniel L. Dent, Brian J. Eastridge, Ramon F. Cestero, Mark Gunst, Helen Markowski, Natasha Keric, Lillian Liao, Deborah L. Mueller

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes. Methods: Medical records were reviewed for all children 5 years or younger with SFs who presented to our Level I trauma center during a 4-year period. Data collected included patient demographics, Glasgow Coma Scale (GCS) score at admission, level of consciousness at the time of injury, type of SF (depressed SF vs. NDSF), magnitude of the SF depression, evidence of neurologic deficit, and the requirement for neurosurgical intervention. Results: We evaluated 1,546 injured young children during the study period. From this cohort, 563 had isolated head injury, and 223 of them had SF. Of the SF group, 163 (73%) had NDSFs, of whom 128 (78%) presented with a GCS score of 15. None of the NDSF patients with a GCS score of 15 required neurosurgical intervention or developed any neurologic deficit. Of the remaining 35 patients with NDSF and GCS score less than 15, 7 (20%) had a temporary neurologic deficit that resolved before discharge, 4 (11%) developed a persistent neurologic deficit, and 2 died (6%). Conclusion: Children 5 years or younger with NDSFs and a normal neurologic examination result at admission do not develop neurologic deterioration.

Original languageEnglish (US)
Pages (from-to)166-169
Number of pages4
JournalJournal of Trauma and Acute Care Surgery
Issue number1
StatePublished - Jul 2014


  • Depressed skull fractures
  • Glasgow Coma Scale
  • neurologic deficit
  • neurosurgical intervention
  • nondepressed skull fractures

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery


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