Type:
Educational Exhibit
Keywords:
Education and training, Congenital, Acute, Perception image, Normal variants, Education, CT, Conventional radiography, Trauma, Bones, Anatomy, Paediatric, Not applicable
Authors:
C. Y. Ng, S. H. M. Y. Y. Alqarooni, C. M. Leung, J. H. Fong, J. Foster; Plymouth/UK
DOI:
10.26044/ecr2020/C-14334
Background
Clinical problem
There remains a diagnostic conundrum in distinguishing fractures and sutures especially within the paediatric population. This is due to the numerous developmental calvarium and skull base sutures that occur normally in children, in which themselves have variable appearances and closure periods.
Significance?
Head trauma in children is a common presentation in the emergency department (children younger than 15 years old make up 33 - 50% of all head injury cases in England and Wales) [1], and is a common cause for morbidity and mortality. Although there is still limited data, McGrath and Taylor 2019, describes a range from 2-20% following head injuries [2].
In the context of abusive head trauma, the analysis by Jenny et al, demonstrated that radiological misdiagnoses do contribute to delay in diagnosis, although not the main contributor [3]. Among the 54 cases that were missed in their study, 9.3% of children unfortunately died as a result, and more than 50% had either reinjuries or developed subsequent medical complications. Likewise, overdiagnosing a normal suture as a fracture could also lead to further unnecessary investigations and safeguarding managements which can result in distress to not only the child but the family involved.