Related Experiment Video
Updated: Feb 17, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Risk Factors for Admission and Prolonged Length of Stay in Pediatric Isolated Skull Fractures
Insights
Pediatric isolated skull fractures (ISF) often lead to hospital admission despite low risk. Concomitant injuries predict prolonged stays, but better risk stratification is needed for emergency department (ED) disposition decisions.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Health Services Research
Background:
- Pediatric isolated skull fractures (ISF) are common injuries in children under five.
- Management strategies for ISF vary, impacting patient disposition and healthcare resource utilization.
Purpose of the Study:
- To assess the management of pediatric ISF patients.
- To determine admission frequency and identify characteristics associated with different patient dispositions (ED discharge, short-term admission, prolonged hospitalization).
Main Methods:
- Retrospective analysis of pediatric patients (<5 years) with ISF using the South Carolina Traumatic Brain Injury Surveillance and Registry System (2001-2011).
- Outcomes included emergency department (ED) discharge, admission <24 hours, and admission >24 hours (prolonged hospitalization).
- Bivariate analyses and polytomous logistic regression identified factors associated with patient disposition.
Main Results:
- Of 527 patients, 53% were discharged from the ED, 29% admitted for <24 hours, and 18% for >24 hours.
- ED discharges were more likely to present to higher-acuity hospitals and less likely to be from high-poverty areas.
- Concomitant injuries were associated with prolonged hospitalizations (OR, 2.21; 95% CI, 1.12-4.36).
Conclusions:
- Hospital admission for pediatric ISF is frequent, even with low risk of deterioration.
- High-poverty patients presenting to high-acuity centers are more often admitted for observation.
- Concomitant injuries are the primary clinical predictor of prolonged hospitalization; improved risk stratification is needed for ED disposition.
Objectives:
This study aimed to assess management of pediatric isolated skull fracture (ISF) patients by determining frequency of admission and describing characteristics associated with patients admitted for observation compared with patients discharged directly from the emergency department (ED) and those requiring a prolonged hospitalization.
Methods:
We evaluated children younger than 5 years who presented with ISF using the South Carolina Traumatic Brain Injury Surveillance and Registry System data from 2001 to 2011. Outcomes analyzed included discharged from ED, admitted for less than 24 hours, and admitted for more than 24 hours (prolonged hospitalization). Bivariate analyses and a polytomous logistic regression model identified factors associated with patient disposition.
Results:
Five hundred twenty-seven patients met the study criteria (ED discharge = 283 [53%]; inpatient <24 hours = 156 [29%]; inpatient >24 hours = 88 [18%]). The mean length of stay for admissions was 1.9 (SD, 1.5) days. In the regression model, ED discharges had greater odds of presenting to levels 2 to 3 hospitals (level 2: odds ratio [OR], 6.16; 95% confidence interval [CI], 3.66-10.39; level 3: OR, 30.98; 95% CI, 10.92-87.91) and lower odds of a high poverty status (OR, 0.20; 95% CI, 0.10-0.40). Prolonged hospitalizations had greater odds of concomitant injuries (OR, 2.21; 95% CI, 1.12-4.36).
Conclusions:
Admission after ISF is high despite a low risk of deterioration. High-poverty patients presenting to high-acuity medical centers are more commonly admitted for observation. Only presence of concomitant injuries was clinically predictive of prolonged hospitalization. The ability to better stratify risk after pediatric ISF would help providers make more informed decisions regarding ED disposition.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
09:49Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
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...
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
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...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption