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This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children\u2009&lt;\u200918\u00a0years old with Glasgow Coma Scale scores\u2009\u2265\u200914 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368\/10,698 (3.4%) children\u2009&lt;\u20092\u00a0years old, and in 676\/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56\/273 (20.5%) of younger children with palpable skull fractures and in 34\/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6\u201324.2%), and in 30\/486 (6.2%) vs 63\/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5\u20137.8%). TBIs on CT were found in 73\/273 (26.7%) and 189\/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2\u201325.9), and in 61\/486 (12.6%) vs 424\/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1\u201312.0).<\/jats:p><jats:p><jats:italic>Conclusions<\/jats:italic>: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.<\/jats:p><jats:p><jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td align=\"left\"><jats:bold>What is Known:<\/jats:bold><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\">\u2022 \u201c<jats:italic>Palpable skull fractures\u201d are a high-risk predictor in the PECARN traumatic brain injury (TBI) rule for children younger than 2\u00a0years.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\">\u2022 <jats:italic>The reliability of physical exam findings suggestive of underlying skull fractures is unclear.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\"><jats:bold>What is New:<\/jats:bold><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\">\u2022 <jats:italic>In children younger than 2\u00a0years of age, approximately one in five of those with \u201cpalpable skull fractures\u201d will actually have a depressed skull fracture on CT, while 60% will have any skull fracture.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\">\u2022 <jats:italic>The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-024-05807-w","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T08:01:57Z","timestamp":1728547317000},"page":"5321-5330","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children"],"prefix":"10.1007","volume":"183","author":[{"given":"Silvia","family":"Bressan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Tancredi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles T.","family":"Casper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liviana","family":"Da Dalt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"5807_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.4103\/2156-7514.194261","volume":"6","author":"C Arneitz","year":"2016","unstructured":"Arneitz C, Sinzig M, Fasching G (2016) Diagnostic and clinical management of skull fractures in children. 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