Greenes et al reported a simple score to help to identify an infant with a skull fracture following head injury. The authors are from Mary Bridge Children's Hospital and Children's Hospital, Harvard Medical School.
Patient selection: head-injured infant
Parameter:
(1) age of the patient in months
(2) size of hematoma
(3) location of the hematoma
Parameter
Finding
Points
age of the patient
>= 12 months
0
6 to 11 months
1
3 to 5 months
2
0 to 2 months
3
size of hematoma
none
0
barely palpable (small)
1
easily palpable (medium)
2
very easily palpable (large)
3
location of the hematoma
frontal
0
occipital
1
temporal
2
parietal
2
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of a skull fracture.
• A score >= 3 had the maximum sensitivity (92%) but relatively low specificity (47%) for skull fracture. All asymptomatic infants with intracranial injuries had a score >= 3.
• A score >= 4 had the maximum Youden index (sensitivity 90%, specificity 78%, YI 68%).
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