Management of Isolated Skull Fractures in Pediatric Patients: A Systematic Review.

Published on Apr 1, 2019in Pediatric Emergency Care1.17
· DOI :10.1097/PEC.0000000000001814
Katelyn Donaldson3
Estimated H-index: 3
,
Xun Li1
Estimated H-index: 1
+ 2 AuthorsSusan R. Durham20
Estimated H-index: 20
(UVM: University of Vermont)
Source
Abstract
OBJECTIVES: Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions. METHODS: Using PubMed and The Cochrane Library databases, a literature search using the search terms (pediatric OR child) AND skull fracture AND (isolated OR linear) was performed. Three hundred forty-three abstracts were identified and screened based on the inclusion criteria: (1) linear, nondepressed ISF; (2) no evidence of intracranial injury; (3) age 18 years or younger; and (4) data on patient outcomes and management. Data including age, Glasgow Coma Scale score on arrival, repeat imaging, admission rates, need for neurosurgical intervention, and patient outcome were collected. Two authors reviewed each study for data extraction and quality assessment. RESULTS: Fourteen articles met the eligibility criteria. Data including admission rates, outcomes, and necessity of neurosurgical intervention were analyzed. Admission rates ranged from 56.8% to 100%; however, only 8 of more than 5000 patients developed new imaging findings after admission, all of which were nonsurgical. Only 1 patient required neurosurgical intervention for a finding evident upon initial evaluation. CONCLUSIONS: Pediatric ISF patients with a presenting Glasgow Coma Scale score of 15 who are neurologically intact and tolerating feeds without concern for nonaccidental trauma or an unstable social environment can safely be discharged following ED evaluation to a responsible caregiver.
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Last. Mony BeniflaH-Index: 16
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Objective The prevalence of skull fractures after mild head trauma is 2 % in children of all ages and 11 % in children younger than 2 years. The current standard management for a child diagnosed with an isolated skull fracture (ISF), in our institute, is hospitalization for a 24-h observation period. Based on data from the literature, less than 1 % of all minor head injuries require neurosurgical intervention. The main objective of this study was to evaluate the risk of neurological deterioratio...
7 CitationsSource
#1Brian P. Blackwood (Rush University Medical Center)H-Index: 8
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Abstract Background Blunt head trauma accounts for a majority of pediatric trauma admissions. There is a growing subset of these patients with isolated skull fractures, but little evidence guiding their management. We hypothesized that inpatient neurological observation for pediatric patients with isolated skull fractures and normal neurological examinations is unnecessary and costly. Methods We performed a single center 10 year retrospective review of all head traumas with isolated traumatic sk...
13 CitationsSource
#1Ian K. White (IU: Indiana University)H-Index: 5
#2Ecaterina Pestereva (IU: Indiana University)H-Index: 1
Last. Daniel H. Fulkerson (IU: Indiana University)H-Index: 15
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OBJECTIVE Children with skull fractures are often transferred to hospitals with pediatric neurosurgical capabilities. Historical data suggest that a small percentage of patients with an isolated skull fracture will clinically decline. However, recent papers have suggested that the risk of decline in certain patients is low. There are few data regarding the financial costs associated with transporting patients at low risk for requiring specialty care. In this study, the clinical outcomes and fina...
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#1Timothy P. Plackett (Loyola University Medical Center)H-Index: 13
#2Sabrina Asturias (SC: University of Southern California)H-Index: 3
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Abstract There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trau...
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#1Eliel N. Arrey (University of Texas Health Science Center at Houston)H-Index: 2
#2Marcia Kerr (University of Texas Health Science Center at Houston)H-Index: 7
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OBJECT In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed. METHODS After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children’s hospital ...
21 CitationsSource
#1Andrew S. Hentzen (KU: University of Kansas)H-Index: 1
#2Stephen D. Helmer (KU: University of Kansas)H-Index: 34
Last. James M. Haan (KU: University of Kansas)H-Index: 19
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Abstract Background Head injuries are common in the pediatric population, but when an isolated skull fracture is found, there are no guidelines for repeat imaging. This study evaluated the need for repeat head computed tomography (CT) for isolated skull fracture. Methods A 10-year retrospective review was conducted of patients 17 years and younger with isolated skull fractures. Data included demographics, injury severity score (ISS), fracture location, clinical indicators of head trauma, intracr...
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BACKGROUND AND OBJECTIVE: Children and adolescents with minor blunt head trauma and isolated skull fractures are often admitted to the hospital. The objective of this study was to describe the injury circumstances and frequency of clinically important neurologic complications among children with minor blunt head trauma and isolated linear skull fractures. METHODS: This study was a planned secondary analysis of a large prospective cohort study in children ,18 years old with blunt head trauma. Dat...
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#2Julia Smith (Primary Children's Hospital)H-Index: 1
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Abstract Purpose In an effort to standardize practices and reduce unnecessary hospital resource utilization, we implemented guidelines for management of patients with isolated skull fractures (ISF). We sought to examine the impact of these guidelines. Methods Patients with nondisplaced/depressed fracture of the skull vault without intracranial hemorrhage were prospectively enrolled from February 2010 to February 2014. Results Eighty-eight patients (median age = 10 months) were enrolled. Fall was...
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#1Saif Hassan (University of Texas Health Science Center at San Antonio)H-Index: 1
#2Stephen M. CohnH-Index: 65
Last. Deborah L. MuellerH-Index: 9
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BACKGROUND: Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes. METHODS: Medical records were reviewed for all children 5 years or younger with SFs w...
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#2Rebecca A Reynolds (Monroe Carell Jr. Children's Hospital at Vanderbilt)
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OBJECTIVE Pediatric isolated linear skull fractures commonly result from head trauma and rarely require surgery, yet patients are often admitted to the hospital-a costly care plan. In this study, the authors utilized a national database to investigate trends in admission for skull fractures across the United States. METHODS Children younger than 18 years with isolated linear skull fracture, according to ICD-9 diagnosis codes in the Kids' Inpatient Database of the Healthcare and Utilization Proje...
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#1Lindsey L. Perea (UPenn: University of Pennsylvania)
#2Madison Morgan (UPenn: University of Pennsylvania)H-Index: 3
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Abstract Background We sought to determine the secondary overtriage rate of pediatric trauma patients admitted to pediatric trauma centers. We hypothesized that pediatric secondary overtriage (POT) would constitute a large percentage of admissions to PTC. Materials and methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003 to 2017 for pediatric (age ≤ 18 y) trauma patients transferred to accredited pediatric trauma centers in Pennsylvania (n = 6). Patients w...
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#1Yura Ko (Ajou University)H-Index: 2
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: The Pediatric Emergency Care Applied Research Network rule helps emergency physicians identify very low-risk children with minor head injury who can forgo head computed tomography. This rule contributes to reduction in lifetime risk of radiation-induced cancers while minimizing missing clinically important traumatic brain injury. However, in intermediate-risk children, decisions on whether to perform computed tomography remain at the emergency physicians' discretion. To reduce this gray zone, ...
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OBJECTIVE Skull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes. METHODSThe authors queried the MarketScan database (2007–2015), identifying pediatric patients (ag...
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