7-month-old boy falls from a bed

Diagnosis: The x-ray shows a skull fracture with a step off. The lines of the fracture are clearly different than the opposite side of the skull. Given the finding and the boy’s age, he was referred for neurosurgical evaluation.

CT has replaced plain films as the standard of care i many facilities due to its accuracy in detecting skull fractures, as well as intracranial bleeding or injury. This may be especially true in cases like this, where there is a palpable step off or depression. In the urgent care center where this patient evaluated, however, the protocol for patients under 1 year of age is to allow the treating physician to employ his imaging medium of choice.

[taq_review]