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Management of uncomplicated skull fractures in children: is hospital admission necessary?
M A Vogelbaum1, B A Kaufman, T S Park
1Department of Neurological Surgery, Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, MO, USA.
Insights
Routine hospital admission may not be necessary for children with uncomplicated skull fractures. A normal neurological exam and head CT are key indicators for considering discharge, avoiding unnecessary hospital stays.
Area of Science:
- Pediatric Emergency Medicine
- Neurosurgery
- Radiology
Background:
- Uncomplicated skull fractures in children often lead to hospital admission for observation.
- The necessity of routine admission for these cases requires further investigation to optimize resource utilization and patient management.
Purpose of the Study:
- To determine if routine hospital admission is necessary for pediatric patients diagnosed with uncomplicated skull fractures.
- To establish criteria for identifying children with skull fractures who can be safely discharged home.
Main Methods:
- Prospective study of pediatric patients with closed-head injuries over 2 years, including skull radiographs and head CT scans.
- Identification and analysis of children with uncomplicated skull fractures.
- Retrospective review of epidural hematoma (EDH) cases to compare diagnostic timelines.
Main Results:
- Forty-four children with uncomplicated skull fractures were admitted; mean age 1.8 years.
- Average hospital length of stay (LOS) was 35 hours, with 50% discharged in under 24 hours.
- No complications were observed in the uncomplicated skull fracture group; EDH diagnosis timelines varied.
Conclusions:
- Children with uncomplicated skull fractures, normal neurological exams, and normal head CT scans may be discharged home.
- Absence of recurrent emesis and no evidence of child abuse are important considerations for discharge.
- A head CT scan is essential for defining an uncomplicated skull fracture.
Objective:
This study was undertaken to determine the necessity for routine hospital admission of children with skull fractures, a normal neurological exam, a normal head CT, and no other injuries ('uncomplicated skull fracture').
Methods:
A prospective study of closed-head injuries in children was done over a 2-year period at St. Louis Children's Hospital. All patients with closed head injuries underwent skull radiographs and a head CT scan. From this cohort, children with uncomplicated skull fractures were identified and studied. For comparison, a retrospective analysis was also performed of the hospital admission records of children admitted over a 5-year period (1990-1994) with the diagnosis of epidural hematoma (EDH) to identify the typical time intervals between injury and documentation of the lesion in these cases.
Results:
Forty-four patients with uncomplicated skull fractures were identified; all had been admitted for observation. Mean age was 1.8 years. Average time between injury and hospital admission was 6.35 h with half of this time being spent in the emergency room. Average LOS was 35 h, but 50% of patients were hospitalized less than 24 h. No patient in this study group suffered a complication related to their inury. Twenty-three patients with EDH had been admitted during the 5-year review period. Slightly more than one-half of patients had their EDH detected within 6 h of injury. The others were diagnosed more than 6 h after injury due to a delay in medical evaluation or a delay in obtaining a computed tomographic (CT) scan after an initial medical evaluation.
Conclusions:
Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered for discharge home. The definition of an uncomplicated skull fracture requires that a head CT be performed on these patients.