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The authors assessed patterns of skull fractures that could play a role in the development of delayed epidural hematoma. All patients who developed a delayed epidural hematoma had a contralateral calvarial fracture on preoperative CT. The contralateral calvarial fracture had perfect sensitivity (100%) for subsequent development of delayed epidural hematoma and a contralateral calvarial fracture involving 2 or more bone plates was particularly significant.