Management of uncomplicated skull fractures in children: is hospital admission necessary? Pediatr Neurosurg 1998 Aug;29(2):96-101
Date
10/30/1998Pubmed ID
9792964DOI
10.1159/000028697Scopus ID
2-s2.0-0031795215 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
OBJECTIVE: This study was undertaken to determine the necessity for routine hospital admission of children with skull fractures, a normal neurological exam, a normal head CT, and no other injuries ('uncomplicated skull fracture').
METHODS: A prospective study of closed-head injuries in children was done over a 2-year period at St. Louis Children's Hospital. All patients with closed head injuries underwent skull radiographs and a head CT scan. From this cohort, children with uncomplicated skull fractures were identified and studied. For comparison, a retrospective analysis was also performed of the hospital admission records of children admitted over a 5-year period (1990-1994) with the diagnosis of epidural hematoma (EDH) to identify the typical time intervals between injury and documentation of the lesion in these cases.
RESULTS: Forty-four patients with uncomplicated skull fractures were identified; all had been admitted for observation. Mean age was 1.8 years. Average time between injury and hospital admission was 6.35 h with half of this time being spent in the emergency room. Average LOS was 35 h, but 50% of patients were hospitalized less than 24 h. No patient in this study group suffered a complication related to their inury. Twenty-three patients with EDH had been admitted during the 5-year review period. Slightly more than one-half of patients had their EDH detected within 6 h of injury. The others were diagnosed more than 6 h after injury due to a delay in medical evaluation or a delay in obtaining a computed tomographic (CT) scan after an initial medical evaluation.
CONCLUSIONS: Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered for discharge home. The definition of an uncomplicated skull fracture requires that a head CT be performed on these patients.
Author List
Vogelbaum MA, Kaufman BA, Park TS, Winthrop ALAuthor
Bruce A. Kaufman MD Adjunct Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentChild Abuse
Child, Preschool
Hematoma, Epidural, Cranial
Humans
Infant
Missouri
Patient Admission
Prospective Studies
Retrospective Studies
Skull Fractures
Time Factors
Tomography, X-Ray Computed
Utilization Review
