Delays in care seeking for young children with accidental skull fractures are common.
AIM
We sought to determine the frequency and patterns of delayed medical care seeking for young children with skull fractures.


METHODS
We identified accidental skull fractures <4 years old, 2011-2012. Child abuse paediatricians abstracted retrospective data and paediatric radiologists re-reviewed images. 'Delays' were defined as presentation at ≥6 h. 'Minor accidents' included falls <4 feet and low force trauma, while 'major accidents' included higher height falls and major force events. We studied the frequency and duration of care delays, the signs or symptoms leading to care, and the duration of delays after signs or symptoms developed.


RESULTS
Two hundred and ten children had accidental skull fractures. Delays were less likely with major accidents (4.9%), than with minor accidents (25.8%) (RR = 0.32 [0.15-0.70]). Children came to care for scalp swelling (STS) (39%), the injury event (36.2%), altered consciousness (15.2%) and vomiting (10.5%). Delayed onset of STS (78.6%) caused most delayed care. Early STS was firm, (17.6%) versus delayed (5.0%), as opposed to soft or fluctuant.


CONCLUSION
Delayed care seeking is common for minor, but not major accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.
['Metz|James B|JB|', 'Otjen|Jeffrey P|JP|', 'Perez|Francisco A|FA|', 'Done|Stephen L|SL|', 'Brown|Emily C B|ECB|', 'Wiester|Rebecca T|RT|', 'Jenny|Carole|C|', 'Ganti|Sheila|S|', 'Feldman|Kenneth W|KW|0000-0002-9020-5223']
D000058:Accidental Falls D002648:Child D002649:Child Abuse D002675:Child, Preschool D006801:Humans D007223:Infant D012189:Retrospective Studies D012887:Skull Fractures
skull fractures child abuse infants and toddlers accidental head injuries delays in medical care