The role of computed tomography in following up pediatric skull fractures

Background Despite the added radiation exposure and costs, the role of computed tomography (CT) in following pediatric skull fractures has not been fully evaluated. Methods We reviewed the radiology reports and images of the initial and follow-up head CT examinations of children with skull fractures to determine whether any interval changes in the fracture morphology and associated complications necessitate a change in clinical management. Results A total of 316 pediatric cases of skull fractures were identified, including 172 patients with and 144 without follow-up scans. At follow-up, 7% of skull fractures were unchanged, 65% healing, and 28% healed. No patient showed findings to cause a change in clinical management or a need for further medical or surgical intervention regardless of the number and patterns of the fractures or the initial intracranial complications such as intracranial hemorrhage, pneumocephalus, and traumatic brain injuries. Conclusions Head CT may be unnecessary in following pediatric skull fractures in asymptomatic patients to avoid added radiation exposure and cost.