Management of uncomplicated skull fractures in children: is hospital admission necessary?
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.
Vogelbaum
M A
MA
Department of Neurological Surgery, Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, MO, USA.
Kaufman
B A
BA
Park
T S
TS
Winthrop
A L
AL
D000293:Adolescent; D002649:Child Abuse; D002675:Child, Preschool; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D008923:Missouri; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014600:Utilization Review