Monitoring
Patients with skull fracture should be followed up until resolution of neurologic symptoms to monitor for evidence of late-onset seizures and resolution of cranial nerve injury. Delayed audiogram at 6 weeks can be considered if indicated. Patients with ongoing symptoms of concussion may be considered for early referral to an interdisciplinary treatment clinic, including a physician with expertise in concussion, where available.[95] See Concussion.
Patients at particularly high infectious risk should also receive laboratory testing including complete blood count and repeat imaging to rule out intracranial infection; this includes patients with fractures involving the frontal or maxillary sinus, or after repair of fractures with metallic hardware, as an abscess or mucopyocele is possible.[96]
Repeat imaging should be performed routinely at 2-month intervals in children, especially if <3 years old, to monitor for growing skull fractures. Grossly contaminated open skull fractures should be followed up in 2 to 3 months with computed tomography scans to rule out an intracranial abscess.[5][45][71]
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