Cranial Vault Fractures Research Articles

A Rare Case of Neonatal Death Due to a Cranial Vault Fracture Following the Use of Obstetric Vacuum Extractor and Review of Literature.

In the course of childbirth, if complications arise during the expulsion of the fetus, instruments can be employed to facilitate delivery. The vacuum extractor, or ventouse, is considered a relatively safe tool associated with a low rate of complications and mortality. However, it is crucial that the instrument be applied in the correct position and that the pulling force is not excessive to minimize damage to the fetal cranial structures. Fractures of the cranial vault following the application of obstetric vacuum extraction are very rare events.This paper presents a case of perinatal death due to cranial vault fracture and subgaleal hematoma following vacuum extractor application. Only through postmortem examination was it possible to identify incorrect positioning of the ventouse, which was lateralized compared to the recommended position. The misplacement of the device led to an imbalance of forces, causing the cranial vault fracture that led to the infant's demise.A thorough postmortem examination is essential in cases of perinatal death resulting from operative delivery to ascertain the cause of death and reconstruct the dynamics of events during childbirth. In particular, the examination of injuries on the decedent neonate may reveal improper positioning of the instrument.

Risk Factors for Acute-Level Hospital Course in Pediatric Craniofacial Fractures.

The pediatric craniofacial trauma literature is limited to single institutions or short study periods. Herein, this study analyzes a national database over 10 years to delineate the epidemiology of pediatric craniofacial fractures and to identify risk factors for acute-level hospital course in the largest series to date. Utilizing the National Trauma Data Bank, pediatric craniofacial fractures admitted between 2010 and 2019 were identified. Descriptive analyses and multivariable regression were performed to identify risk factors for acute-level hospital course. A total of 155,136 pediatric craniofacial fracture cases were reviewed, including cranial vault (49.0%), nasal (22.4%), midface (21.0%), mandibular (20.2%), and orbital floor fractures (13.7%). Midface and orbital floor fractures occurred commonly as multicraniofacial fractures. Cranial vault fractures were the most common among all age groups, but frequency declined with age. In contrast, facial fractures increased with age. Despite the inherent complexity of multicraniofacial trauma, isolated fractures remained a concern for acute-level hospital course.Cranial vault and midface fractures had an increased risk of intracranial injury and intensive care unit admission (P<0.001). Mandibular and midface fractures had an increased risk for cervical spine fracture and tracheostomy (P<0.001). Patient and injury-specific risk factors among the fractures with the strongest association for each outcome-cranial vault and mandible-were identified. The inherent limitations of prior studies-geographical biases, small cohorts, and short-term study periods-were addressed. Describing the independent contribution of each craniofacial fracture to the risk of acute-level hospital course outcomes can be employed to better optimize risk stratification, counseling, and management.

5. Can location and severity of cranial vault fracture predict post-traumatic sequelae?

5. Can location and severity of cranial vault fracture predict post-traumatic sequelae?

Cranial injuries as evidence for violent conflict during the Gallinazo Phase in the Moche Valley of North Coastal Peru

In this study cranial injuries in human skeletal remains from the site of Cerro Oreja in the Moche Valley of north coastal Peru provide a proxy measure of violence during the Gallinazo Phase preceding the rise of the Southern Moche State and are used to assess the role that violent conflict may have played in state formation. Both healed and perimortem cranial vault fractures are present in the sample of 116 individuals from Cerro Oreja. These injuries provide evidence of both intra- and intergroup violence during the Early Intermediate Period (EIP) occupation of the site, ca. 400 BCE – AD 200. The injury rate is significantly higher than that observed in a residential sample (AD 200 – 800) from the site of Moche or in an aggregated EIP sample from the larger Andean region. While escalating violence during the Gallinazo Phase might be expected if warfare contributed to the genesis of this primary state, this was not statistically verified here. The data do suggest that a climate of violence prevailed at Cerro Oreja in the years preceding the rise of the Southern Moche State and that violent conflict likely contributed to the emergence of this hegemonic polity.

The use of Thiocetam in the complex therapy of combat-related brain contusion

Each patient presents a unique set of characteristics and challenges when it comes to acute cerebral ischemia resulting from craniocerebral injury. The aim of this study is to investigate the utilization of Thiocetam as part of a comprehensive treatment approach for combat-related cerebral contusion and to assess the therapeutic effects of Thiocetam in patients with mild and moderate closed combat craniocerebral trauma in comparison to standard basic therapy. Materials and methods. 79 patients with mild and moderate closed combat craniocerebral trauma were examined. Among them, 76 patients experienced craniocerebral trauma due to an explosive blast injury, which included conditions such as brain concussion, mild cerebral contusion, and cranial vault fractures. All patients were admitted to the department during the acute period of their injuries. During the study, various clinical and functional methods were employed to assess the condition of the central nervous system. These methods were used to evaluate the effects of the complex treatment administered to the patients. Results. The administration of Thiocetam to the patients did not result in an increase in excitability, nervousness, or sleep disturbances. Furthermore, the examination of autonomic reactivity following Thiocetam treatment revealed that the indicator of normal autonomic reactivity increased to 60 % in the treated group, whereas it only increased to 42 % in the control group. Additionally, the patients with initially heightened vegetative reactions experienced a decrease from 42.8 % to 17.9 % in the treated group, while the control group saw a decrease from 38.5 % to 23.1 %. In terms of clinical outcomes, a positive effect was observed in 94 % of patients in the Thiocetam-treated group within the first 5 days. In comparison, the control group showed a positive clinical effect in 76 % of cases. This improvement was evident both in the clinical field and based on indicators of autonomic reactivity in EEG data, as well as cognitive function assessed by the MMSE cognitive function test scale. Conclusions. The utilization of Thiocetam during the acute phase of mild and moderate closed combat craniocerebral trauma enhances the neuroprotective effects of basic therapy. The combined drug Thiocetam, which possesses both nootropic and neuroprotective effects, offers the advantage of reducing or even avoiding the side effects commonly associated with traditional racetam nootropics.

Pediatric Cranial Vault and Skull Base Fractures.

Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.

Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis.

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.

What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. The final sample consisted of 559 patients (mean age, 45.9years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P<.01). Relative to privately insured subjects, uninsured subjects were 23 times (P<.05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P<.05). Cranial vault fractures (odds ratio, 7.24; P<.05) and upper cervical fractures (odds ratio, 63.27; P<.05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.

A method for the development of cranial fracture histology slides.

Cranial vault fractures are of medicolegal interest as they have long‐term impacts to someone's health and may contribute to an individual's death. The ability to distinguish antemortem from perimortem fractures and to assess the age of the injury is increasingly dependent on histology. Despite the increasing role of histology in assessing the microanatomy of osseous fractures, there are no methods currently available which account for the nuances and difficulties in creating high‐quality histologic slides of cranial vault fractures that allow visualization of cellular features associated with healing bone. The authors present a modified method specific to slide development of human cranial vault fractures derived from the trial‐and‐error process of creating 730 such slides over a 3‐year period which are suitable for the evaluation of the tissues, cells, and nuclei involved in fracture healing. This method adapts and troubleshoots typical histological procedures including sample excision, fixation, decalcification, dehydrating, clearing, embedding, microtomy, and staining, and introduces new procedures including preprocessing photography and cassette placement. By implementing these modifications, the number of poor‐quality slides that required a new section to be sent to the histology laboratory was greatly reduced. Proactively implementing this new method into cranial fracture histologic slide development significantly reduces the number of slide rejections due to common issues like folding, chatter, or insufficient staining, saving both time and financial resources for forensic practitioners, researchers, and histotechnologists.

Malar and maxillary fractures among pediatric patients and the risk factors for mortality

No studies have characterized the morbidity and mortality of maxillary & malar fractures on a national scale. The aim of this study was to examine the risk factors for mortality in pediatric patients who had sustained maxillary and malar fractures by using a national pediatric hospital inpatient care database. This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the cause of injury. The primary outcome variable was mortality rate. Additional predictor variables included age, gender, race, income, payer information, year and place of injury, number of facial fractures, concomitant facial fractures, other fractures of the body, and intracranial/internal organ injury. Univariate and multivariate regression models were performed to assess risk factors for mortality. Statistical significance was set to a p-value <.05. A total of 5859 patients met the inclusion criteria. The most common age group was 13-17 years of age (n=3816, 65.1%). Motor vehicle accidents were the most common mechanism of injury (n=2172, 37.1%). The presence of cranial vault (OR=2.81, p=.017), skull base (OR=2.72, p <.001), and vertebral column fractures (OR=2.13, p =.016), as well as sub-arachnoid hemorrhage (OR=4.75, p =.005), traumatic pneumothorax/hemothorax (OR=2.16, p =.015), and heart/lung injury (OR=3.37, p <.001) were each independently associated with increased odds of mortality. Patients in their late teens most commonly sustained malar and maxillary fractures, likely due to general trends in craniomaxillofacial development. The presence of other fractures located in close proximity to the mid-face increased the risk of mortality among pediatric patients with malar and maxillary fractures. This may be explained by the anatomical approximation of the mid-face to vital neurovascular structures of the head, which, when damaged, may prove fatal.

Cranial vault imaging for pediatric head trauma using a radial VIBE MRI sequence.

Head trauma is the most common indication for a CT scan. In this pilot study, the authors assess the feasibility of a 5-minute high-resolution 3D golden-angle (GA) stack-of-stars radial volumetric interpolated breath-hold examination (VIBE) MRI sequence (GA-VIBE) to obtain clinically acceptable cranial bone images and identify cranial vault fractures compared to CT. Patients younger than 18 years of age presenting after head trauma were eligible for the study. Three clinicians reviewed and assessed 1) slice-by-slice volumetric CT and inverted MR images, and 2) 3D reconstructions obtained from inverted MR images and the gold standard (CT). For each image set, reviewers noted on 5-point Likert scales whether they recommended that a repeat scan be performed and the presence or absence of cranial vault fractures. Thirty-one patients completed MRI after a clinical head CT scan was performed. Based on CT imaging, 8 of 31 patients had cranial fractures. Two of 31 patients were sedated as part of their clinical MRI scan. In 30 (97%) of 31 MRI reviews, clinicians agreed (or strongly agreed) that the image quality was acceptable for clinical diagnosis. Overall, comparing MRI to acceptable gold-standard CT, sensitivity and specificity of fracture detection were 100%. Furthermore, there were no discrepancies between CT and MRI in classification of fracture type or location. When compared with the gold standard (CT), the volumetric and 3D reconstructed images using the GA-VIBE sequence were able to produce clinically acceptable cranial images with excellent ability to detect cranial vault fractures.

Types of Fractures in Cranial Vault Followed by a Head Injury: A Retrospective Cross Sectional Study

Aim: To assess the types of fracture of cranial vault followed by head injury. Study Design: Retrospective cross-sectional study Place and duration: This study was conducted at Pakistan Institute of Medical Sciences Islamabad, Pakistan from June 2020 to June 2021. Methodology: A total of 125 patients with head injury were considered in this study. Total 69 (55.2%) patients were from rural areas and 56 (44.8%) were from urban areas. Types of cranial vault fractures, their radiological findings and cause of injury were analyzed. Result: Out of 125 patients, 102 were identified with severe head injuries. 53 (42.4%) had a fracture in the frontal bone. 49 (39.2%) patients had got injured due to violent assault. Conclusion: Most of the patients who had received a head injury and frontal bone fracture were from rural areas. The most commonly fractured bone in these cases is the frontal bone. The commonest cause of injury in the head was a violent assault. Keywords: Head injury, cranial vault fracture, frontal bone fracture, violent assault

The Repository of Antemortem Injury Response (REPAIR): an online database for skeletal injuries of known ages.

An accurate assessment of time since fracture is an essential component of abuse and death investigations; however, little evidence-based research exists on dating fractures, especially those of the cranial vault. This is primarily due to difficulties in procuring human fracture specimens of known posttraumatic survival times. The aim of this article is to introduce a new database through which limitations imposed by sample procurement may be mitigated. The Repository of Antemortem Injury Response (REPAIR) is a digitally accessible database of cranial vault fractures of known ages with extensive contextual information and visual documentation in the form of photography, radiography, and histological photomicrographs. This repository is a multifunctional tool that serves as a case submission portal for cranial fractures of known posttraumatic survival time, a sample database for research on fracture healing and rates of repair, a resource for comparative assessments of cranial fractures in forensic casework, and an educational tool for healing fracture histomorphology.

Different Patterns and Distribution of Skull Fractures in Road Traffic Accidents

Background: The head is a common site of trauma in road accidents, and despite safety initiatives, the mortality rate for head injuries has not decreased. Despite the existence of a mandatory helmet law, both mortality and morbidity rates are on the rise. Head injuries are also associated with injuries to the neck, spine, stomach, abdomen, and pelvic cavity.Objectives: To study different patterns and distribution of skull fractures in different kinds of road accidents.Methods: In the Department of Forensic Medicine at Osmania General Hospital 4,213 post-mortem Examinations were carried out during the period ( August 2019 to January 2021. In 784 cases, death was attributed to Road Traffic Accidents. Head injury was present in 634 cases. In 471 cases out of 784, skull fractures were found. The data has been collected from PME reports and inquest reports, relatives and friends of the deceasedResults: Most frequently noted type of fracture is fissured in 59.8% of the cases. Injuries in RTA’s are almost always due to blunt force on cranial vault. Highest number of fractures are seen in temporal 100 (21%), Fractures occurring in cranial vault alone is 336(71.3%), BOS alone is 28(5.94%). Fractures extending into BOS are 308(65.3%). In the base of skull, overall highest frequency of fracture is found in MCF (alone in BOS) with 109 (23.1%), then in PCF (alone in BOS) is 71 (15%), least in ACF 39(8.28%). Only fracture MCF in all over skull is seen in 11(2.33%) cases, PCF 11(2.33%) casesConclusion: Commonest fracture of skull in road traffic accidents is the fissured fracture in the cranial vault, mostly in temporal bone. Fractures of cranial vault most frequently extend to middle cranial fossa and posterior cranial fossa till foramen magnum which are responsible for immediate deaths. Victims who survived till hospital admission are almost half in number. Strict enforcement of road safety regulations and improving emergency medical services may prevent untimely deaths and disabilities caused by RTAs.

Gunshot missile caliber and type estimation using superposition method by exit gunshot cranial vault fracture

A case of missile group identification by comparative examination using the image superposition method is presented. Identification was carried out using a skeletonized body vault exit gunshot fracture. The exit gunshot buttonhole fracture shape and dimensions reflected the bullet caliber and its flank profile. The entrance injury located on the anterior arch of the first cervical vertebra and the basilar part of the occipital bone, in this case, had no identification significance.

Biophysical mechanisms of the formation of wound channels in non-penetrating gunshot craniocerebral wounds

Objective ‒ to develop recommendations for optimization of primary surgical treatment of gunshot penetrating craniocerebral wounds on the basis of theoretical and applied study of one of the sections of wound ballistics ‒ biophysical mechanisms of wound canal formation, concomitant impenetrable wounds and intracranial injuries.Materials and methods. The medical histories of 155 wounded who received a non-pe-netrating craniocerebral injury during the hostilities in the East of Ukraine in 2014‒2020 were studied. All of the wounded were males between 18 and 60 years old (mean age ‒ 35.1 years). To study the biophysical features of the formation of different types of wound canals at a given non-lethal kinetic energy transferred to the head tissues, the type of the wounding projectile, the flight trajectory, the nature of gunshot injuries to the soft tissues of the cranial vault and skull fractures and intracranial injuries were determined according to the data of clinical stu-dies and computed tomography and compared with the results of theoretical studies using the laws of wound ballistics.Results. There were 11 (7.1 %) bullet (only tangential) wounds, and 144 (92.9 %) shrapnel. The formation of wound channels depends on the type of the wounding projectile and its kinetic energy. Non-penetrating firearms bullet and shrapnel tangential craniocerebral wounds are caused by the destructive effect of injuring shells on the tissues, which at the moment of collision with the head have both destructive kinetic energy (&gt;80 J) and less than destructive kinetic energy. Blind craniocerebral injuries are caused only by the traumatic effects of fragments with a small (&lt;80 J) kinetic energy.Conclusions. With gunshot non-penetrating single shrapnel blind wounds, the wounds do not have a zone of secondary necrosis, and the zone of primary necrosis is small or insignificant, which makes it possible not to carve soft tissues around the wound during primary surgical treatment, but only to remove necrotic tissues. With gunshot non-penetrating shrapnel tangential and blind craniocerebral wounds, when the soft tissue wounds of the cranial vault do not gap, small size (damage to the skin, subcutaneous tissue to aponeurosis), primary surgical treatment is not performed. Such wounds are treated with a toilet and aseptic dressings. Wound canals ending in gunshot fractures are subject to primary surgical treatment in the same way as gunshot fractures.

CT findings and the prognostic value of the Koret CT score in cats with traumatic brain injury.

ObjectivesThe aims of this study were to evaluate associations between abnormal head CT findings and outcome, and to examine the prognostic value of the Koret CT score (KCTS) in cats sustaining acute traumatic brain injury (TBI).MethodsThe medical records of cats hospitalised with TBI that underwent head CT scans within 72 h of admission were retrospectively reviewed. CT scans were evaluated independently by a radiologist and a neurologist who were blinded to the outcome. A KCTS and modified Glasgow Coma Scale (MGCS) were assigned to each cat and the association between abnormal CT findings, KCTS, MGCS and outcome were analysed.ResultsFourteen cats were included in the study: nine (64.2%) survivors and five (35.7%) non-survivors. Of the nine cats that were discharged, one was a short-term survivor (10 days) and eight (57.1%) were long-term survivors (⩾6 months). Abnormal CT findings included lateral ventricle asymmetry/midline shift (42.8%), intracranial haemorrhage (35.7%), caudotentorial lesions (14.2%) and cranial vault fractures (14.2%), all of which were depressed. Intracranial haemorrhage was found to be significantly and negatively associated with short-term (P = 0.005) and long-term (P = 0.023) survival. KCTS was significantly associated with short-term survival (P = 0.002) and long-term survival (P = 0.004). A KCTS cut-off value of 2 yielded a 100% sensitivity and 100% specificity for short-term survival and 100% sensitivity and 80% specificity for long-term survival. A MGCS cut-off value of ⩾13 was associated with a 100% sensitivity and 100% specificity for short-term survival, and with a 100% sensitivity and 80% specificity for long-term survival.Conclusions and relevanceKCTS, performed up to 72 h from injury, can be used as an additional diagnostic tool for the prediction of survival in cats with TBI.

Are Complex Skull Fractures Indicative of Either Child Abuse or Major Trauma in the Era of 3-Dimensional Computed Tomography Imaging?

The aim of the study was to determine whether complex skull fractures are more indicative of child abuse or major trauma than simple skull fractures. This is a retrospective chart and imaging review of children diagnosed with a skull fracture. Subjects were from 2 pediatric tertiary care centers. Children younger than 4 years who underwent a head computed tomography with 3-dimensional rendering were included. We reviewed the medical records and imaging for type of skull fracture, abuse findings, and reported mechanism of injury. A complex skull fracture was defined as multiple fractures of a single skull bone, fractures of more than 1 skull bone, a nonlinear fracture, or diastasis of greater than 3 mm. Abuse versus accident was determined at the time of the initial evaluation with child abuse physician team confirmation. From 2011 to 2012, 287 subjects were identified by International Classification of Diseases, Ninth Revision, code. The 147 subjects with a cranial vault fracture and available 3-dimensional computed tomography composed this study's subjects. The average age was 12.3 months. Seventy four (50.3%) had complex and 73 (49.7%) had simple fractures. Abuse was determined in 6 subjects (4.1%), and a determination could not be made for 5 subjects. Adding abused children from 2013 to 2014 yielded 15 abused subjects. Twelve of the abused children (80%) had complex fractures; more than the 66 (48.5%) of 136 accidentally injured children (P = 0.001; relative risk = 1.65 [1.21-2.24]). However, among children with a complex fracture, the positive predictive value for abuse was only 7%. Complex skull fractures frequently occur from accidental injuries. This study suggests that the presence of complex skull fractures should not be used alone when making a determination of abuse.

Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features.

BackgroundTraumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features.Hypothesis/ObjectivesTo describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF.AnimalsNinety‐one dogs and 95 cats with TSF identified on CT.MethodsMulticenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1‐week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement.ResultsThe cranial vault was affected more frequently in dogs (P = .003), whereas the face and base of the cranium more often was affected in cats (P < .001). Cats presented with multiple fractures more frequently (P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs (P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7‐8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel‐Haenszel's method [ORMH], 0.2; 95% CI, 0.1‐0.6; P = .004). Most affected animals (84.9%) survived the first week post‐trauma. Death was more likely with fractures of the cranial vault (P = .003), especially when fragmented (P = .007) and displaced (P = .004).Conclusions and Clinical ImportanceTraumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week.

Computed tomographic findings in dogs with head trauma and development of a novel prognostic computed tomography-based scoring system.

OBJECTIVE To characterize CT findings and outcomes in dogs with head trauma and design a prognostic scale. ANIMALS 27 dogs admitted to the Koret School Veterinary Teaching Hospital within 72 hours after traumatic head injury that underwent CT imaging of the head. PROCEDURES Data were extracted from medical records regarding dog signalment, history, physical and neurologic examination findings, and modified Glasgow coma scale scores. All CT images were retrospectively evaluated by a radiologist unaware of dog status. Short-term (10 days after trauma) and long-term (≥ 6 months after trauma) outcomes were determined, and CT findings and other variables were analyzed for associations with outcome. A prognostic CT-based scale was developed on the basis of the results. RESULTS Cranial vault fractures, parenchymal abnormalities, or both were identified via CT in 24 of 27 (89%) dogs. Three (11%) dogs had only facial bone fractures. Intracranial hemorrhage was identified in 16 (59%) dogs, cranial vault fractures in 15 (56%), midline shift in 14 (52%), lateral ventricle asymmetry in 12 (44%), and hydrocephalus in 7 (26%). Hemorrhage and ventricular asymmetry were significantly and negatively associated with short- and long-term survival, respectively. The developed 7-point prognostic scale included points for hemorrhage, midline shift or lateral ventricle asymmetry, cranial vault fracture, and depressed fracture (1 point each) and infratentorial lesion (3 points). CONCLUSIONS AND CLINICAL RELEVANCE The findings reported here may assist in determining prognoses for other dogs with head trauma. The developed scale may be useful for outcome assessment of dogs with head trauma; however, it must be validated before clinical application.