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Ten-Year Analysis of Complications Related to Simple Basilar Skull Fractures in Children Presenting to a Trauma
Sydney Ryan1, Hilary Hewes1, Stephen F Fenton2
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Insights
Children with uncomplicated basilar skull fractures (BSFs) can often be safely discharged from the emergency department. This study found no major complications in these pediatric patients, suggesting discharge is feasible with proper follow-up care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Neurology
Background:
- Head trauma is a frequent reason for pediatric emergency department visits.
- Skull fractures occur in 4-30% of these cases, with basilar skull fractures (BSFs) often leading to admission.
- The risk of complications in children with isolated BSFs requires further investigation.
Purpose of the Study:
- To determine if children diagnosed with an isolated basilar skull fracture (BSF) experience complications that would prevent safe discharge from the emergency department (ED).
Main Methods:
- A retrospective review of 174 pediatric patients (0-18 years) diagnosed with an isolated BSF over 10 years.
- Isolated BSF defined by specific criteria: nondisplaced fracture, normal neurological exam, Glasgow Coma Score of 15, no intracranial hemorrhage, no pneumocephalus.
- Complications assessed included death, vascular injury, delayed hemorrhage, sinus thrombosis, meningitis, prolonged hospital stay (>24 hours), or return visits within 3 weeks.
Main Results:
- No deaths, meningitis, vascular injuries, or delayed bleeding events were observed.
- 17.2% of patients had a hospital length of stay (LOS) over 24 hours; 5.2% returned within 3 weeks.
- Among those with prolonged LOS, some required subspecialty consultation, IV fluids, or had cerebrospinal fluid leaks or facial nerve concerns.
Conclusions:
- Pediatric patients with uncomplicated basilar skull fractures (BSFs) may be safely discharged from the ED.
- Discharge readiness depends on reliable follow-up, tolerance of oral fluids, absence of cerebrospinal fluid leak, and appropriate specialist evaluation.
Objectives:
Head trauma is a common presenting complaint among children requiring urgent medical attention, accounting for more than 600,000 emergency department (ED) visits annually, 4% to 30% of which identify skull fractures among the patient's injuries. Previous literature shows that children with basilar skull fractures (BSFs) are usually admitted for observation. We studied whether children with an isolated BSF have complications precluding them from safe discharge home from the ED.
Methods:
We performed a retrospective review of ED patients aged 0 to 18 years given a simple BSF diagnosis (defined by nondisplaced fracture, with normal neurologic examination, Glasgow Coma Score of 15, no intracranial hemorrhage, no pneumocephalus) during a 10-year period to identify complications associated with their injury. Complications were defined as death, vascular injury, delayed intracranial hemorrhage, sinus thrombosis, or meningitis. We also considered hospital length of stay (LOS) longer than 24 hours or any return visit within 3 weeks of the original injury.
Results:
Of the 174 patients included in the analysis, there were no deaths, cases of meningitis, vascular injury, nor delayed bleeding events. Thirty (17.2%) patients required a hospital LOS longer than 24 hours and 9 (5.2%) returned to the hospital within 3 weeks of discharge. Of those with LOS longer than 24 hours, 22 (12.6%) patients needed subspecialty consultation or intravenous fluids, 3 (1.7%) had cerebrospinal fluid leak, and 2 (1.2%) had a concern for facial nerve abnormality. On the return visits, only 1 (0.6%) patient required readmission for intravenous fluids because of nausea and vomiting.
Conclusions:
Our findings suggest that patients with uncomplicated BSFs can be safely discharged from the ED if the patient has reliable follow-up, is tolerating oral fluids, has no evidence of cerebrospinal fluid leak, and has been evaluated by appropriate subspecialists before discharge.
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