Skull Base Fractures are Markers of Severe Forces in the First Two Years of Life

While experience indicates that basilar skull fractures are an uncommon injury in the first two years of life, an evidential basis for this observation is lacking in the forensic pathology literature. The aim of this study was to determine the incidence and forensic significance of basilar skull fractures in the first two years of life. This retrospective analysis reviewed pediatric deaths over a 17-year period in a large metropolitan medical examiner jurisdiction and included the deaths of infants and children under 24 months of age. All cases had a cause of death statement of “blunt head trauma”, “blunt head and neck trauma” or “blunt trauma”. Sixty-three cases were found, 23 of which had basilar skull fractures. The most common circumstance with basilar skull fracture was pedestrian versus motor vehicle accidents (57%), followed by inflicted injury (30%), and vehicle accidents in which the child was an occupant (13%). As such, basilar skull fractures are uncommon injuries that are the end result of the application of significant forces to the head. The discovery of a basilar skull fracture without an appropriate history of the accidental application of severe forces should cause those tasked with the investigation of child injuries and death to carefully consider inflicted head trauma.