Delays in care seeking for young children with accidental skull fractures are common.

AIM We sought to determine the frequency and patterns of delayed medical care seeking for young children with skull fractures. METHODS We identified accidental skull fractures < 4 years-old, 2011-2012. Child abuse pediatricians abstracted retrospective data and pediatric radiologists re-reviewed images. "Delays" were defined as presentation at ≥ 6 hours. "Minor accidents" included falls < 4 feet and low force trauma, while "major accidents" included higher height falls and major force events. We studied the frequency and duration of care delays, the signs or symptoms leading to care, and the duration of delays after signs or symptoms developed. RESULTS Two hundred and ten children had accidental skull fractures. Delays were less likely with major accidents (4.9%), than with minor accidents (25.8%) (RR=0.32 (0.15-0.70)). Children came to care for scalp swelling (STS) (39%), the injury event (36.2%), altered consciousness (15.2%) and vomiting (10.5%). Delayed onset of STS (78.6%) caused most delayed care. Early STS was firm, (17.6%) vs delayed (5.0%), as opposed to soft or fluctuant. CONCLUSION Delayed care seeking is common for minor, but not major accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.