title: Impact of newly adopted guidelines for management of children with isolated skull fracture.
abstract: OBJECTIVE
  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=10months) were enrolled. Fall was the most common mechanism of injury (87%). The overall admission rate was 57%, representing an 18% decrease from that reported prior to guideline implementation (2003-2008; p=0.001). Guideline criteria for admission included vomiting, abnormal neurologic exam, concern for abuse, and others. Forty-two percent of patients were admitted outside of the guideline, primarily because of young age (20%). Patients transferred from another hospital (36%) were more likely to be admitted, though the majority (63%) did not meet admission criteria. No ED-discharged patient returned for neurologic symptoms, and none reported significant ongoing symptoms on follow-up phone call.
  
  
  CONCLUSIONS
  Implementation of a new guideline for management of ISF resulted in a reduction of admissions without compromising patient safety. Young age remains a common concern for practitioners despite not being a criterion for admission. Interhospital transfer may be unnecessary in many cases.
authors.affiliation: Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah. Electronic address: r.metzger@utah.edu.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Metzger
authors.affiliation: Trauma Service, Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Julia
authors.initials: J
authors.lastname: Smith
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wells
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Lesley
authors.initials: L
authors.lastname: Eldridge
authors.affiliation: Division of Pediatric Emergency Medicine, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Maija
authors.initials: M
authors.lastname: Holsti
authors.affiliation: Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Scaife
authors.affiliation: Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.affiliation: Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rollins
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009460:Neurologic Examination; D011446:Prospective Studies; D012887:Skull Fractures / Q000150:complications / Q000209:etiology / Q000628:therapy*; D014589:Utah; D014839:Vomiting / Q000150:complications
keywords: Children; Head injury; Resource utilization; Skull fracture