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J Neurosurg Pediatr. 2015 Dec;16(6):703-8. doi: 10.3171/2015.4.PEDS1545. Epub 2015 Sep 4.

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Author information

1
Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children's Memorial Hermann Hospital, Houston, Texas.

Abstract

OBJECT:

In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed.

METHODS:

After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children's hospital between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus.

RESULTS:

Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36 (11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7-395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2-43 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit.

CONCLUSIONS:

Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.

KEYWORDS:

CMHH = Children’s Memorial Hermann Hospital; CONSORT = Consolidated Standards for Reporting of Trials; CPS = Child Protective Service; LOS = length of stay; MOI = mechanism of injury; NDSF = nondisplaced skull fracture; linear skull fracture; nondisplaced; pediatric head trauma

PMID:
26339955
DOI:
10.3171/2015.4.PEDS1545
[Indexed for MEDLINE]

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