{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:01:42Z","timestamp":1782860502907,"version":"3.54.5"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Bilateral skull fractures in infancy often raise suspicion for abuse. Nevertheless, literature suggests that they may occur accidentally. However, empiric data are lacking.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>This multicenter retrospective review aimed to characterize bilateral skull fractures in a large sample.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Participants and Setting<\/jats:title>\n            <jats:p>Medical records for infants younger than 24 months with bilateral skull fractures involving hospital consultation with a child abuse pediatrician (CAP) were reviewed from 2005 to 2020 at 13 nationally represented institutions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Standardized data collection across institutions included historical features, fracture characteristics, and additional injuries, as well as the CAP's determination of accident versus abuse. Pooled data were analyzed for descriptive and bivariate analyses.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>For 235 cases, 141 were accidental, and 94 abuse. The majority occurred in young infants, and a history of a fall was common in 70% of cases. More than 80% involved both parietal bones. Bilateral simple linear fractures were more common in accidental cases, 79% versus 35%, whereas a complex fracture was more frequent in abuse cases, 55% versus 21% (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Almost two thirds of accidental cases showed approximation of the fractures at the sagittal suture, compared with one third of abuse cases (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Whereas focal intracranial hemorrhage was seen in 43% of all cases, diffuse intracranial hemorrhage was seen more in abuse cases (45%) than accidents (11%). Skin trauma was more common in abusive than accidental injury (67% vs 17%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), as were additional fractures on skeletal survey (49% vs 3%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>A fall history was common in bilateral skull fractures deemed accidental by a CAP. Most accidental cases involved young infants with biparietal simple linear fractures, without skin trauma or additional fractures. A skeletal survey may aid in the determination of accidental or abusive injury for unwitnessed events resulting in bilateral skull fractures in infants.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002704","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:03:09Z","timestamp":1649797389000},"page":"329-334","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Understanding Bilateral Skull Fractures in Infancy"],"prefix":"10.1097","volume":"39","author":[{"given":"Mandy A.","family":"O'Hara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Valvano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisha","family":"Kashyap","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health, Columbia University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie C.","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Loma Linda University Children\u2019s Hospital, Loma Linda, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela N.","family":"Bachim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite M.","family":"Care","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Cincinnati Children's Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa K.","family":"Egge","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Loma Linda University Children\u2019s Hospital, Loma Linda, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie S.","family":"Kondis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St. Louis Children\u2019s Hospital, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"Lenane","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Rochester Medical Center, Rochester, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis B.R.","family":"Maddocks","sequence":"additional","affiliation":[{"name":"Department of Radiology, New York-Presbyterian Hospital, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James B.","family":"Metz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Vermont Children\u2019s Hospital, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne K.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen N.","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, UT Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle T.","family":"Ruda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Health Science Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Segal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Sugarman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri","family":"Weeks","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wesley Children's Hospital, Wichita, KS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resmiye","family":"Oral","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital at Dartmouth, Lebanon, NH."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,4,13]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1542\/peds.2007-1959","article-title":"Incidence of fractures attributable to abuse in young hospitalized children: results from analysis of a United States database","volume":"122","year":"2008","journal-title":"Pediatrics"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1001\/archpedi.1993.02160250089028","article-title":"Fractures in young children. Distinguishing child abuse from unintentional injuries","volume":"147","year":"1993","journal-title":"Am J Dis Child"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"a1518","DOI":"10.1136\/bmj.a1518","article-title":"Patterns of skeletal fractures in child abuse: systematic review","volume":"337","year":"2008","journal-title":"BMJ"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1136\/adc.59.3.246","article-title":"Skull fracture and the diagnosis of abuse","volume":"59","year":"1984","journal-title":"Arch Dis Child"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2214\/ajr.149.1.173","article-title":"Radiographic characteristics of skull fractures resulting from child abuse","volume":"149","year":"1987","journal-title":"Am J Roentgenol"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1542\/peds.75.2.340","article-title":"Serious head injury in infants: accident or abuse?","volume":"75","year":"1985","journal-title":"Pediatrics"},{"key":"bib8-20250504","first-page":"e200","article-title":"Are complex skull fractures indicative of either child abuse or major trauma in the era of 3-dimensional computed tomography imaging?","volume":"38","year":"2020","journal-title":"Pediatr Emerg Care"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1542\/peds.2008-2467","article-title":"Skeletal surveys in infants with isolated skull fractures","volume":"123","year":"2009","journal-title":"Pediatrics"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/00005373-199807000-00039","article-title":"Bilateral pediatric skull fractures: accident or abuse?","volume":"45","year":"1998","journal-title":"J Trauma"},{"key":"bib11-20250504","first-page":"94","article-title":"When a system of child protection becomes abusive\u2014case report: bilateral linear parietal skull fractures in an infant from accidental occipital trauma","volume":"109","year":"2013","journal-title":"J S C Med Assoc"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1159\/000516972","article-title":"Bilateral parietal skull fractures in infants attributable to accidental falls","volume":"56","year":"2021","journal-title":"Pediatr Neurosurg"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/j.1750-3639.2008.00203.x","article-title":"Accidental traumatic head injury in infants and young children","volume":"18","year":"2008","journal-title":"Brain Pathol"},{"key":"bib14-20250504","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/j.1556-4029.2010.01391.x","article-title":"Age-dependent fracture characteristics of rigid and compliant surface impacts on the infant skull\u2014a porcine model","volume":"55","year":"2010","journal-title":"J Forensic Sci"},{"key":"bib15-20250504","first-page":"15","article-title":"The infant with bilateral skull fractures: diagnostic considerations in consultation with a child abuse pediatrician","volume":"11","year":"2019","journal-title":"J Inj Violence Res"},{"key":"bib16-20250504","first-page":"93","article-title":"Biomechanical fragility of the infant skull","volume":"94","year":"1985","journal-title":"Z Rechtsmed"},{"key":"bib17-20250504","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.crad.2016.11.015","article-title":"Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses","volume":"72","year":"2017","journal-title":"Clin Radiol"},{"issue":"2 pt 1","key":"bib18-20250504","first-page":"179","article-title":"Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age","volume":"90","year":"1992","journal-title":"Pediatrics"},{"key":"bib19-20250504","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1742-1241.1983.tb08457.x","article-title":"Bilateral compound fractures of the infant skull caused by dog bite","volume":"37","year":"1983","journal-title":"Br J Clin Pract"},{"key":"bib20-20250504","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00005373-199501000-00010","article-title":"The medicolegal implications of bilateral cranial fractures in infants","volume":"38","year":"1995","journal-title":"J Trauma"},{"key":"bib21-20250504","doi-asserted-by":"crossref","first-page":"e872","DOI":"10.1097\/PEC.0000000000001795","article-title":"3 Cases of inflicted skull crush injuries in infants","volume":"37","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"bib22-20250504","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1542\/peds.2011-1545","article-title":"Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review","volume":"130","year":"2012","journal-title":"Pediatrics"},{"key":"bib23-20250504","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s00247-014-3064-3","article-title":"The yield of high-detail radiographic skeletal surveys in suspected infant abuse","volume":"45","year":"2015","journal-title":"Pediatr Radiol"},{"key":"bib24-20250504","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1097\/PEC.0000000000000199","article-title":"Three-dimensional computed tomography skull reconstructions as an aid to child abuse evaluations","volume":"31","year":"2015","journal-title":"Pediatr Emerg Care"},{"key":"bib25-20250504","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/archdischild-2014-306803","article-title":"Biomechanical characteristics of head injuries from falls in children younger than 48 months","volume":"101","year":"2016","journal-title":"Arch Dis Child"},{"key":"bib26-20250504","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11832-014-0551-x","article-title":"Stair falls: caregiver\u2019s \u201cmissed step\u201d as a source of childhood fractures","volume":"8","year":"2014","journal-title":"J Child Orthop"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002704","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:09:28Z","timestamp":1746382168000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002704"}},"subtitle":["A Retrospective Multicenter Case Review"],"short-title":[],"issued":{"date-parts":[[2022,4,13]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002704","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2022,4,13]]}}}