Pediatric Skull Fractures Contacting Sutures: Relevance in Abusive Head Trauma.

Abstract

<b>OBJECTIVE.</b> The purpose of this study was to assess the incidence of pediatric skull fractures contacting cranial sutures in abusive versus accidental trauma. <b>MATERIALS AND METHODS.</b> A retrospective review was conducted of head CT studies performed for pediatric head trauma at a free-standing tertiary care children's hospital from 2012 to 2019. Statistical odds ratios were evaluated to assess the significance of skull fracture extension to sutures in abusive versus accidental injury. A two-proportion <i>Z</i>-test was used to determine the statistical significance of suture type contacted by skull fractures in accidental versus abusive injury. <b>RESULTS.</b> The records of 47 children with 57 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated. The patients were 1-36 months old. Fifty-one abusive skull fractures (89%) terminated in contact with a cranial suture; 35 of the 51 (69%) touched two or more sutures, and 12 touched three or more sutures. Forty-two of the 54 (78%) accidental skull fractures contacted a suture; only 3 of the 42 (7%) touched two sutures, and none touched more than two sutures (odds ratio, 28.4 [95% CI, 7.6-105.9]; <i>p</i> < .001). In the abusive fractures, the suture most commonly contacted by a fracture line was the lambdoid (43%; <i>p</i> < .04), followed by the sagittal (23%), coronal (21%), temporal-squamous (12%), and metopic (1%) sutures. There was no statistical difference in which suture was contacted by fracture lines in accidental cases. <b>CONCLUSION.</b> Skull fracture contacting cranial sutures is common in abusive and accidental pediatric head trauma. However, that a fracture contacts two or more cranial sutures is an imaging finding not previously described that has a significantly higher association with abusive than with accidental head injury.