Clinical comparison of the predictive value of the simple skull x-ray and 3 dimensional computed tomography for skull fractures of children

Abstract

Objective: In the pediatric population the skull has not yet undergone ossification and it is assumed that the diagnostic rate of skull fractures by simple X-rays are lower than that of adults. It has been recently proposed that the diagnostic rates of skull fractures by 3-dimensional computer tomography (3D-CT) are higher than simple X-rays. The authors therefore attempted to compare the diagnostic rates of pediatric skull fractures by simple X-rays and 3D-CTs with respect to the type of fracture.

Methods: One-hundred patients aged less than 12 years who visited the Emergency Center for cranial injury were subject to simple X-rays and 3D-CTs. The type and location of the fractures were compared and Kappa statistical analysis and the t-test were conducted.

Results: Among the 100 pediatric patients, 65 were male and 35 were female. The mean age was 50±45 months. 63 patients had simple skull fractures and 22 had complex fractures, and the types of fractures were linear fractures in 74, diastatic fractures 15, depressed fractures in 10, penetrating fracture in 1, and greenstick fractures in 3 patients. Statistical difference was observed for the predictive value of simple skull fractures' diagnostic rate depending on the method for diagnosis. A significant difference of the Kappa value was noted in the diagnosis of depressed skull fractures and diastatic skull fractures.

Conclusion: In the majority of pediatric skull fractures, 3D-CT showed superior diagnosis rates compared to simple skull X-rays and therefore 3D-CT is recommended whenever skull fractures are suspected. This is especially true for depressed skull fractures and diastatic skull fractures.

Keywords: 3-dimensional computer tomography; Depressed skull fracture; Diastatic skull fracture; Pediatric skull fracture; Simple skull radiography.

Fig. 1

Linear skull fracture in the simple X-ray and 3 dimensional computed tomography. Linear skull fractures on the occipital bone (A and B) and parietal bone (C) show not in the simple X-ray but clearly in the 3 dimensional computed tomography.

Fig. 2

Depressed skull fracture in the simple X-ray and 3 dimensional computed tomography. A : Depressed skull fracture on the parietal bone shows clearly both in the simple X-ray and 3 dimensional computed tomography. B and C : Depressed skull fracture on the outer table of the parietal bone shows not in the simple X-ray but clearly in the 3 dimensional computed tomography.

Fig. 3

Diastatic skull fractures in the simple X-ray and 3 dimensional computed tomography. A and B : Diastatic skull fractures on the lambdoid, temporo-parietal and occipito-mastoid sutures show clearly both in the simple X-ray and 3 dimensional computed tomography. C and D : Diastatic skull fractures on the coronal, lambdoid, and temporo-parietal sutures show not in the simple X-ray but clearly in the 3 dimensional computed tomography. Arrows indicate site of fracture in each pictures.