Are skull radiographs useful in the evaluation of asymptomatic infants following minor head injury?

Head injuries constitute a common problem in the pediatric population. Recent studies indicate that infants are at increased risk for skull fractures following head trauma. The purpose of our study is to examine the utility of skull radiographs in asymptomatic infants presenting after a minor head injury. We retrospectively reviewed the records of all head-injured infants who presented to our emergency department between March 1990 and July 1991. All symptomatic patients and all infants who did not undergo radiologic evaluation were excluded from the analysis. During the study period, 35 asymptomatic infants were evaluated in our emergency department following head trauma. The mean age of the study patients was 5.5 +/- 3.8 months; 54% were male; and falls accounted for the injury in 88% of cases. The skull radiograms were normal in 30 patients, equivocal in two, and positive for a parietal skull fracture in three. The three infants who sustained skull fractures were male, were younger than three months, and had fallen from heights not exceeding three feet. Computed head tomograms revealed no intracranial pathology in these patients. We conclude that all infants who present following minor skull trauma should undergo radiologic evaluation.