Related Experiment Video
Updated: Mar 31, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Observation for isolated traumatic skull fractures in the pediatric population: unnecessary and costly
Brian P Blackwood1, Jonathan F Bean2, Corinne Sadecki-Lund2
1Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Department of Surgery, 225 E. Chicago Ave, Box 63, Chicago, IL 60611; Rush University Medical Center, Department of General Surgery, 1750W. Harrison Street, Suite 785, Chicago, IL 60612.
Insights
Pediatric isolated skull fractures are low-risk injuries. Most children with these fractures and normal exams can be safely discharged from the emergency department, avoiding unnecessary hospital costs.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Health Economics
Background:
- Blunt head trauma is a leading cause of pediatric trauma admissions.
- Isolated skull fractures represent a growing subset of these cases, lacking clear management guidelines.
- Current management often involves unnecessary inpatient observation, increasing healthcare costs.
Purpose of the Study:
- To evaluate the necessity and cost-effectiveness of inpatient neurological observation for pediatric patients with isolated skull fractures and normal neurological examinations.
- To determine the risk of complications in this patient population.
Main Methods:
- A 10-year retrospective review of pediatric patients with isolated traumatic skull fractures and normal neurological exams.
- Exclusion of patients with penetrating trauma, depressed fractures, intracranial hemorrhage, skull base fractures, pneumocephalus, or poly-trauma.
- Analysis of patient demographics, fracture characteristics, clinical course, hospital costs, and need for surgical intervention.
Main Results:
- 71 pediatric patients with isolated skull fractures were analyzed; 77.5% were admitted for observation, while 22.5% were discharged.
- No patients required neurosurgical intervention or repeat imaging during their initial admission.
- Admitted patients incurred average additional hospital costs of $4,291.50 compared to discharged patients (p<0.0001).
Conclusions:
- Pediatric isolated skull fractures are generally low-risk conditions with minimal complications.
- Current evidence suggests safe discharge from the emergency department without inpatient observation is feasible.
- Altering management protocols could lead to significant healthcare cost savings.
Background:
Blunt head trauma accounts for a majority of pediatric trauma admissions. There is a growing subset of these patients with isolated skull fractures, but little evidence guiding their management. We hypothesized that inpatient neurological observation for pediatric patients with isolated skull fractures and normal neurological examinations is unnecessary and costly.
Methods:
We performed a single center 10year retrospective review of all head traumas with isolated traumatic skull fractures and normal neurological examination. Exclusion criteria included: penetrating head trauma, depressed fractures, intracranial hemorrhage, skull base fracture, pneumocephalus, and poly-trauma. In each patient, we analyzed: age, fracture location, loss of consciousness, injury mechanism, Emergency Department (ED) disposition, need for repeat imaging, hospital costs, intracranial hemorrhage, and surgical intervention.
Results:
Seventy-one patients presented to our ED with acute isolated skull fractures, 56% were male and 44% were female. Their ages ranged from 1week to 12.4years old. The minority (22.5%) of patients were discharged from the ED following evaluation, whereas 77.5% were admitted for neurological observation. None of the patients required neurosurgical intervention. Age was not associated with repeat imaging or inpatient observation (p=0.7474, p=0.9670). No patients underwent repeat head imaging during their index admission. Repeat imaging was obtained in three previously admitted patients who returned to the ED. Cost analysis revealed a significant difference in total hospital costs between the groups, with an average increase in charges of $4,291.50 for admitted patients (p<0.0001).
Conclusion:
Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Further studies are necessary to change clinical practice, but our research indicates that these patients can be discharged safely from the ED without inpatient observation. This change in practice, additionally, would allow for huge health care dollar savings.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
08:27Development of an Uncomplicated Mild Traumatic Brain Injury Model Modified by Weight-Drop Method and Evidenced by Magnetic Resonance Imaging
Published on: April 11, 2025
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...