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Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study
Cory McFall1, Alexandra D Beier2,3, Kelsey Hayward3
1Divisions of1Pediatric Critical Care and.
Insights
Infectious complications from pediatric open skull fractures are rare. Short-term, single-antibiotic treatment and emergency department wound closure are effective for most cases.
Area of Science:
- Pediatric neurosurgery
- Trauma surgery
- Infectious disease
Background:
- Pediatric open skull fractures require careful management to prevent infectious complications.
- Current antibiotic and operative strategies vary, necessitating an evaluation of their impact.
Purpose of the Study:
- To evaluate contemporary management of pediatric open skull fractures.
- To assess the influence of antibiotic and operative variations on infectious complication rates.
Main Methods:
- Retrospective review of 138 pediatric patients with open calvarial skull fractures across 6 trauma centers (2009-2017).
- Data collected included injury characteristics, antibiotic regimens (choice, route, duration), operative management, and infectious outcomes.
- Analysis focused on identifying associations between management variations and infection incidence.
Main Results:
- 48.6% frontal fractures, 80.4% depressed fractures; 58.7% underwent fragment elevation.
- Average IV antibiotic duration was 4.6 days; 38.4% received single IV antibiotic for <4 days.
- Low infection rate (2 cases: superficial wound infection, hardware infection); no meningitis or abscess.
- Neither antibiotic strategy nor wound care site correlated with infection development.
Conclusions:
- Infectious complications are infrequent in pediatric open skull fractures.
- Antibiotic strategy and wound care location did not significantly impact infection rates.
- Short-term, single-agent antibiotic therapy and emergency department closure are suitable for minimally contaminated fractures without significant depression.
Objective:
The authors sought to evaluate the contemporary management of pediatric open skull fractures and assess the impact of variations in antibiotic and operative management on the incidence of infectious complications.
Methods:
The records of children who presented from 2009 to 2017 to 6 pediatric trauma centers with an open calvarial skull fracture were reviewed. Data collected included mechanism and anatomical site of injury; presence and depth of fracture depression; antibiotic choice, route, and duration; operative management; and infectious complications.
Results:
Of the fractures among the 138 patients included in the study, 48.6% were frontal and 80.4% were depressed; 58.7% of patients underwent fragment elevation. The average duration of intravenous antibiotics was 4.6 (range 0-21) days. Only 53 patients (38.4%) received a single intravenous antibiotic for fewer than 4 days. and 56 (40.6%) received oral antibiotics for an average of 7.3 (range 1-20) days. Wounds were managed exclusively in the emergency department in 28.3% of patients. Two children had infectious complications, including a late-presenting hardware infection and a superficial wound infection. There were no cases of meningitis or intracranial abscess. Neither antibiotic spectrum or duration nor bedside irrigation was associated with the development of infection.
Conclusions:
The incidence of infectious complications in this population of children with open skull fractures was low and was not associated with the antibiotic strategy or site of wound care. Most minimally contaminated open skull fractures are probably best managed with a short duration of a single antibiotic, and emergency department closure is appropriate unless there is significant contamination or fragment elevation is necessary.
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