Depressed skull fracture in a 7-month-old who fell from bed.

Abstract

Accidents in children represent a significant cause of morbidity and mortality in the United States. Falls are the most frequent cause of accidental injury and rank fourth behind motor vehicle accidents, fires, and drowning as the cause of accidental death in children.1 Falling out of bed is a relatively common occurrence. Although childhood falls from bed frequently will prompt an urgent visit to the pediatrician, rarely do they produce significant injury.2-4 We present a case in which a fall of 24 inches from bed resulted in an uncomplicated, simple depressed skull fracture. A 7-month-old infant was brought to the emergency department by her parents after an unwitnessed fall from bed. On multiple, independent interviews, her parents provided a consistent, unwavering history. The patient and her father were lying in bed, when the father was called out to help the mother with the 2-year-old brother. After leaving the bedroom, the father heard a thud and returned immediately to find the patient on the floor crying. She was consoled after 5 minutes, at which time the father noted a depression on the right side of her head. The parents sought medical attention immediately. A thorough evaluation in the emergency department showed a normal physical and neurologic exam, with no evidence of external trauma except for a 2 × 4 × 0.5-cm depression of the skull in the right parietal region. A computerized tomography image showed a depressed skull fracture of the right parietal bone, with no evidence of underlying brain injury. The patient was admitted to the hospital for close observation and additional evaluation of suspected …