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Radiographs showed 162 fractures(2.7%of all radiographs and 18%of study group radiographs).Staff in the accident and emergency department missed 37(23%)fractures.CT scan was done on 156 children,of whom 107 had a skull fracture,23 children were found to have intracranial injuries on CT.The presence of neurological abnormalities had a sensitivity for identification of intracranial injury of 91%(21 of 23)and a negative predictive value of 97%.The corresponding values for skull fracture on radiography were 65%(15 of 23)and 83%.Four children died of whom only one had a skull fracture.In children,severe intracranial injury can occur in the absence of skull fracture.Skull radiography is not a reliable predictor of intracranial injury and is indicated only to confirm or exclude a suspected depressed fracture or penetrating injury,and when non- accidental injury is suspected,including in all infants younger than 2 years.Clinical neurological abnormalities are a reliable predictor of intracranial injury.If imaging is required,it should be with CT and not skull radiography. |
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CAT scan
CAT scan,abnormal
CAT scan,head injury
children
head injury
head injury,management of
head injury,pediatric
neurologic signs
skull fracture
skull fracture,pediatric
skull x-ray,abnormal
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