Nonaccidental trauma (NAT) is one of the leading causes of serious injury and death among young children in the United States, with a high proportion of head injury. Numerous studies have demonstrated the safety of discharge of infants with isolated skull fractures (ISFs); however, these same studies have noted that those infants with suspected abuse should not be immediately discharged. The authors aimed to create a standardized protocol for evaluation of infants presenting with skull fractures to our regional level I pediatric trauma center to best identify children at risk.

A protocol for evaluation of NAT was developed by our pediatric trauma committee, which consists of evaluation by neurosurgery, pediatric surgery, and ophthalmology, as well as the pediatric child protection team. Social work evaluations and a skeletal survey were also utilized. Patients presenting over a 2-year period, inclusive of all infants younger than 12 months at the time of presentation, were assessed. Factors at presentation, protocol compliance, and the results of the workup were evaluated to determine how to optimize identification of children at risk.

A total of 45 infants with a mean age at presentation of 5.05 months (SD 3.14 months) were included. The most common stated mechanism of injury was a fall (75.6%), followed by an unknown mechanism (22.2%). The most common presenting symptoms were swelling over the fracture site (25 patients, 55.6%), followed by vomiting (5 patients, 11.1%). For the entire population of patients with skull fractures, there was suspicion of NAT in 24 patients (53.3% of the cohort). Among the 30 patients with ISFs, there was suspicion of NAT in 13 patients (43.3% of the subgroup).

Infants presenting with skull fractures with intracranial findings and ISFs had a substantial rate of concern for the possibility of nonaccidental skull fracture. Although prior studies have demonstrated the relative safety of discharging infants with ISFs, it is critical to establish an appropriate standardized protocol to evaluate for infants at risk of abusive head trauma.

非意外创伤 (NAT) 是美国幼儿严重受伤和死亡的主要原因之一，头部受伤的比例很高。大量研究证明了孤立性颅骨骨折 (ISF) 婴儿出院的安全性；然而，这些相同的研究也指出，那些疑似受虐待的婴儿不应立即出院。作者旨在创建一个标准化协议，用于评估向我们的区域一级儿科创伤中心呈现颅骨骨折的婴儿，以最好地识别有风险的儿童。

我们的儿科创伤委员会制定了评估 NAT 的方案，其中包括神经外科、儿科外科和眼科以及儿科儿童保护团队的评估。还使用了社会工作评估和骨骼调查。对就诊时间超过 2 年的患者进行了评估，包括所有在就诊时小于 12 个月的婴儿。对介绍、协议依从性和检查结果的因素进行评估，以确定如何优化识别有风险的儿童。

总共包括 45 名平均年龄为 5.05 个月（标准差 3.14 个月）的婴儿。最常见的损伤机制是跌倒 (75.6%)，其次是未知机制 (22.2%)。最常见的症状是骨折部位肿胀（25 名患者，55.6%），其次是呕吐（5 名患者，11.1%）。对于所有颅骨骨折患者，有 24 名患者（占队列的 53.3%）怀疑 NAT。在 30 名 ISF 患者中，13 名患者（亚组的 43.3%）怀疑 NAT。

因颅内发现和 ISF 出现颅骨骨折的婴儿非常担心非意外颅骨骨折的可能性。尽管先前的研究已经证明了 ISF 婴儿出院的相对安全性，但建立适当的标准化方案来评估有头部虐待风险的婴儿至关重要。