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Evaluating the Role of a Neurosurgery Consultation in Management of Pediatric Isolated Linear Skull Fractures

Kavya Kommaraju1, Jeffrey H Haynes2, Ann M Ritter3

  • 1Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA, kommarajuk2@vcu.edu.

Pediatric Neurosurgery
|January 24, 2019
PubMed

Insights

Routine pediatric neurosurgical consultations for children with isolated linear skull fractures (ILSF) and a Glasgow Coma Scale (GCS) of 14-15 do not typically change patient management or require further interventions.

Area of Science:

  • Pediatric Neurosurgery
  • Trauma Care
  • Pediatric Traumatology

Background:

  • Isolated linear skull fractures (ILSF) are common in pediatric head trauma.
  • The necessity of neurosurgical consultation for these injuries is often debated.

Purpose of the Study:

  • To evaluate the impact of pediatric neurosurgical consultations on the management of pediatric patients with ILSF and Glasgow Coma Scale (GCS) scores of 14-15.
  • To determine if consultations alter clinical decision-making regarding further imaging or interventions.

Main Methods:

  • Retrospective chart review of 127 pediatric patients with ILSF at a Level 1 Pediatric Trauma Center over 10 years.
  • Exclusion of complex head injuries, including open fractures, hemorrhage, and lower GCS scores (≤13).
  • Analysis of neurosurgical recommendations for changes in acuity of care, additional imaging, or invasive procedures.

Main Results:

  • The most common injury was unilateral parietal bone fracture (46.5%), with falls being the primary mechanism (81.1%).
  • All eligible patients received neurosurgical consultations within 24 hours of arrival.
  • No neurosurgical recommendations were made for additional imaging, changes in care acuity, or invasive procedures.

Conclusions:

  • Routine pediatric neurosurgical consultation for children with ILSF and GCS scores of 14-15 does not appear to influence clinical management.
  • Current consultation practices may not be altering the course of care for these specific pediatric head injuries.
Abstract

Keywords:
Isolated linear skull fracturesNeurosurgery consultation

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