Original ArticleObservation for isolated traumatic skull fractures in the pediatric population: unnecessary and costly
Section snippets
Objectives
Our aims were to identify pediatric patients at our institution with a presenting diagnosis of an isolated skull fracture, and to determine their outcomes. Using this information we planned to evaluate whether inpatient observation was necessary, determine health care costs associated with an isolated skull fracture, and formulate a management algorithm. We hypothesized that an isolated skull fracture in a neurologically intact pediatric patient would correlate with a very low risk of
Materials and methods
After obtaining IRB approval, we performed a single center retrospective review at a free-standing major metropolitan pediatric level-one trauma center. The medical records of all pediatric trauma patients presenting to the emergency department with ICD-9 codes indicating head trauma (803.00, 803.01, 803.06, 803.09, 854.00, 959.00, 660890, and 727915) were reviewed from June of 2004 through June of 2014.
Inclusion criteria included patients presenting to the emergency department with CT of the
Results
Over the 10-year period examined, 163 patients were identified as having a head trauma with a skull fracture. There were 71 patients that satisfied the selection criteria that were outlined for the study. Of these patients 56% were male and 44% were female. Patient ages ranged from 1 week old to 12.4 years old with an average age of 19 months. Sixty of the total seventy-one patients (85%) were aged less than three years of age (Fig. 2).
The majority (77.5%) of patients were admitted for inpatient
Discussion
Traumatic brain injuries are one of the most common serious injuries that pediatric patients sustain [23]. We identified that patients with a normal neurologic exam in the setting of an isolated skull fracture often are without associated intracranial injury or significant risk of long-term sequalae. CT scan imaging allowed us to identify those patients that had isolated non-depressed skull fractures. It was a valuable tool in assessing both the degree of fracture and any other intra-cranial
Conclusion
In conclusion, inpatient neurological observation is unnecessary for pediatric patients with isolated skull fractures, and normal neurological examinations. We propose that these patients may be safely discharged home with outpatient follow up as long as there is no concern for NAT (Fig. 4). Appropriate discharge of low risk patients would be expected to decrease health care costs associated with pediatric blunt head trauma without negatively impacting patient care.
Author contribution
Brian P. Blackwood: first author, literature search, writing (65%), study design, data collection, data analysis and interpretation.
Jonathan F. Bean: second author, literature search, writing (35%), study design, data collection, data analysis.
Corinne Sadecki-Lund: data collection and interpretation.
Irene B. Helenowski: data analysis.
Rashmi Kabre: data interpretation, manuscript preparation.
Catherine J. Hunter: study design, data analysis, data interpretation, manuscript preparation.
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