Basilar Skull Fracture Signs and Management in Infants
Clinical Presentation and Diagnosis
- The American College of Radiology recommends considering basilar skull fracture in infants with signs such as hemotympanum, bleeding from the ear canal, periorbital ecchymosis, and postauricular ecchymosis, although these classic signs may be delayed or absent in the acute setting 1, 2
- According to the American College of Radiology's PECARN criteria, any signs of basilar skull fracture automatically place an infant in the "high-risk" category, with approximately 4.4% risk of clinically important traumatic brain injury, regardless of Glasgow Coma Scale score 1, 2, 3, 4
Immediate Management and Imaging
- Non-contrast CT head is mandatory for any infant with suspected basilar skull fracture signs, as plain skull radiographs are inadequate and miss up to 50% of intracranial injuries 3, 4, 5
- CT angiography should be strongly considered as basilar skull fractures carry high risk for traumatic arterial dissection 5
Special Considerations
- The American College of Radiology suggests considering non-accidental trauma in infants with basilar skull fracture, especially with inconsistent history or unexplained mechanism 6, 4
- All infants with signs of basilar skull fracture require hospital admission for close neurological observation with serial examinations, even if initial Glasgow Coma Scale is 15 4, 5