title: Isolated linear skull fractures in children with blunt head trauma.
abstract: 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. Data were collected in 25 emergency departments. We analyzed patients with Glasgow Coma Scale scores of 14 or 15 and isolated linear skull fractures. We ascertained acute neurologic outcomes through clinical information collected during admission or via telephone or mail at least 1 week after the emergency department visit.
  
  
  RESULTS
  In the parent study, we enrolled 43,904 children (11,035 [25%] <2 years old). Of those with imaging studies, 350 had isolated linear skull fractures. Falls were the most common injury mechanism, accounting for 70% (81% for ages <2 years old). Of 201 hospitalized children, 42 had computed tomography or MRI repeated; 5 had new findings but none required neurosurgical intervention. Of 149 patients discharged from the hospital, 20 had repeated imaging, and none had new findings.
  
  
  CONCLUSIONS
  Children with minor blunt head trauma and isolated linear skull fractures are at very low risk of evolving other traumatic findings noted in subsequent imaging studies or requiring neurosurgical intervention. Hospital admission for neurologically normal children with isolated linear skull fractures after minor blunt head trauma for monitoring is typically unnecessary.
authors.affiliation: Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; epowell@northwestern.edu.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Powell
authors.affiliation: Division of Pediatric Emergency Medicine, Children's National Medical Center, George Washington School of Medicine, Washington, District of Columbia;
authors.forename: Shireen M
authors.initials: SM
authors.lastname: Atabaki
authors.affiliation: Departments of Radiology.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wootton-Gorges
authors.affiliation: Surgery.
authors.forename: David
authors.initials: D
authors.lastname: Wisner
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan;
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, Nemours Children's Hospital, Orlando, Florida;
authors.forename: Todd
authors.initials: T
authors.lastname: Glass
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah;
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan;
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.affiliation: Holy Cross Hospital, Silver Spring, Maryland; and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Emergency Medicine, and.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Emergency Medicine, and Pediatrics, University of California, Davis School of Medicine, Davis, California;
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011446:Prospective Studies; D018570:Risk Assessment; D012887:Skull Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014481:United States; D019564:Unnecessary Procedures
keywords: craniocerebral trauma; head trauma; pediatric trauma; skull fracture