Clinical and Radiological Characteristics of Pediatric Skull Fractures and Their Association with Neurosurgical Intervention: A Retrospective Cohort Study

Background: Traumatic brain injury is a major cause of morbidity in children. This study evaluates pediatric patients with skull fractures in the emergency department to determine independent factors associated with neurosurgical intervention. Methods: This single-center retrospective study included 133 patients under 18 years old with CT-confirmed skull fractures following head trauma. Demographics, trauma mechanisms, neurological status, fracture characteristics, and intracranial injuries were recorded. Firth penalized logistic regression examined factors associated with surgery. Results: The mean age was 4.47 years, and falls were the most common trauma mechanism (63.9%). Pneumocephalus and intracranial hemorrhage were each present in 24.8% of patients. In total, 12 patients (9.0%) required neurosurgical intervention. In univariate analyses, depressed fractures, comminuted fractures, pneumocephalus, and intracranial hemorrhage were strongly associated with intervention. In the multivariable model, age, intracranial hemorrhage and depressed fracture were the factors retaining statistical significance (p = 0.017, p = 0.022, p = 0.013). Conclusions: Intracranial hemorrhage showed the strongest independent statistical association with neurosurgical intervention. Although depressed, comminuted fractures and pneumocephalus were associated with surgery in univariate analyses, their independent contributions could not be reliably established due to limited surgical events. Clinical decisions must integrate neurological status and fracture characteristics.