{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:57:26Z","timestamp":1779195446025,"version":"3.51.4"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,30]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>After being struck in the left side of the head by a thin metal rod, a 10-year-old, previously healthy male presented to an urgent care clinic with a subcentimeter scalp laceration in the midline parietal area and a normal neurological exam. Evaluation included skull radiographs, which did not demonstrate a definitive fracture. Following laceration repair, the patient was discharged to home.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Subsequently, progressive neurological symptoms prompted his family to bring him back for evaluation 2 days later, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed an open, depressed skull fracture. Surgical intervention was performed with debridement and closure. The patient was placed on a course of intravenous antibiotics and had no subsequent evidence of infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In cases involving potential cranial perforation by a thin projectile, use of CT imaging or MRI, rather than plain radiographs, may prevent a delay in diagnosis and subsequent complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22386","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T06:34:42Z","timestamp":1675060482000},"source":"Crossref","is-referenced-by-count":1,"title":["Occult pediatric skull fracture and implications for delay in diagnosis: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Maxwell","family":"Gruber","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nate","family":"Klingele","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ohio State University, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy","family":"Monson","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.","family":"Sribnick","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"497","article-title":"Epidemiology of global pediatric traumatic brain injury: qualitative review","volume":"91","author":"Dewan MC","year":"2016","unstructured":"Dewan MC, Mummareddy N, Wellons JC 3rd, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg. 2016;91:497\u2013509.e1.27018009"},{"issue":"8","key":"b2","series-title":"JAMA Pediatr","first-page":"700","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk","volume":"167","author":"Miglioretti DL","year":"2013","unstructured":"Miglioretti DL, Johnson E, Williams A,  The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700\u2013707."},{"issue":"9696","key":"b3","series-title":"Lancet","first-page":"1160","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","author":"Kuppermann N","year":"2009","unstructured":"Kuppermann N, Holmes JF, Dayan PS,  Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160\u20131170.19758692"},{"key":"b4","series-title":"BMJ Case Rep","first-page":"bcr2016216767","article-title":"Missing the point: self-inflicted traumatic brain injury in psychosis","volume":"2016","author":"Maruca-Sullivan PE","year":"2016","unstructured":"Maruca-Sullivan PE, Goldenberg MN, Cone DC, Ciarleglio J. Missing the point: self-inflicted traumatic brain injury in psychosis. BMJ Case Rep. 2016;2016:bcr2016216767.28003228"},{"issue":"3","key":"b5","series-title":"J Neurosurg","first-page":"333","article-title":"Infection after depressed fracture of skull. Implications for management of nonmissile injuries","volume":"36","author":"Jennett B","year":"1972","unstructured":"Jennett B, Miller JD. Infection after depressed fracture of skull. Implications for management of nonmissile injuries. J Neurosurg. 1972;36(3):333\u2013339.5059972"},{"key":"b6","series-title":"Essential Forensic Neuropathology","article-title":"Biomechanics of injury","author":"Fowler D","year":"2009","unstructured":"Fowler D. Biomechanics of injury. In: Troncoso J, Fowler D, Rubio A, eds. Essential Forensic Neuropathology. Philadelphia, PA: Lippincott Williams and Wilkins; 2009."},{"issue":"12","key":"b7","series-title":"Childs Nerv Syst","first-page":"3021","article-title":"The importance of skull impact site for minor mechanism head injury requiring neurosurgical intervention","volume":"36","author":"Tavor O","year":"2020","unstructured":"Tavor O, Boddu S, Glatstein M, Lamberti M, Kulkarni AV, Scolnik D. The importance of skull impact site for minor mechanism head injury requiring neurosurgical intervention. Childs Nerv Syst. 2020;36(12):3021\u20133025.32303834"},{"issue":"10","key":"b8","series-title":"Eur J Pediatr","first-page":"1597","article-title":"Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic head injuries","volume":"179","author":"Niele N","year":"2020","unstructured":"Niele N, van Houten M, Tromp E, van Goudoever JB, Pl\u00f6tz FB. 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