Infants With Isolated Skull Fracture: What Are Their Clinical Characteristics, and Do They Require Hospitalization?

Greenes, David S.; Schutzman, Sara A.

doi:10.1016/s0196-0644(97)70158-6

Cited by 87 publications

(59 citation statements)

References 24 publications

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“…Although some children with isolated skull fractures may require hospital admission for on-going symptoms or evaluation of nonaccidental trauma, [15][16][17][18] outpatient care with close follow-up is a safe option for many. 10 At our study institution, the baseline hospitalization rate for children with isolated skull fractures was similar to the national average. 8 We hypothesized that we could safely reduce hospitalization rates without impacting quality of care.…”

Section: Methodssupporting

confidence: 51%

“…[8][9][10][11][12] Among children with isolated skull fractures who had repeat neuroimaging, few had additional traumatic findings 12 and none required further neurosurgical intervention. 9,12 Similar to previously published data, none of the children in our study required any acute interventions, and the majority of hospitalized children were discharged the following day.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Children with isolated skull fractures, defined as a skull fracture without intracranial hemorrhage, are at exceedingly low risk for clinical decompensation. [8][9][10][11][12] Despite this low risk, hospitalization rates for children with isolated skull fractures approaches 80% nationally. 8 Because hospitalization is associated with increased cost, 8 as well as the potential for medication errors 13 and abstract BACKGROUND AND OBJECTIVE: Although children with isolated skull fractures rarely require acute interventions, most are hospitalized.…”

mentioning

confidence: 99%

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A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Lyons¹,

Stack²,

Monuteaux³

et al. 2016

Pediatrics

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BACKGROUND AND OBJECTIVE: Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. METHODS: We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. RESULTS: We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5–16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%–77%) and decreased to 46% (34/72, 95% confidence interval, 35%–60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. CONCLUSIONS: We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions.

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Section: Methodssupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Lyons¹,

Stack²,

Monuteaux³

et al. 2016

Pediatrics

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“…[6][7][8][9][10][12][13][14] The prospective design and large sample size of the current study enabled us to report the risk of deterioration and need for neurosurgical intervention with precision. The data also include a large number of children ,2 years old in whom skull fractures are common and mental status assessment may be difficult, resulting in greater uncertainty about the optimal management strategy.…”

Section: Discussionmentioning

confidence: 99%

“…1 Several retrospective reports have shown that young children with isolated skull fractures generally have uncomplicated clinical courses, but these data have not been confirmed in a rigorous prospective study. [6][7][8][9] Information about current practice patterns suggests that there is significant variation among institutions and many young children with isolated skull fractures are admitted to the hospital. 10 The purpose of the current study was to determine (1) the incidence of neurologic deterioration resulting in neurosurgical intervention and (2) the incidence of traumatic findings on follow-up imaging studies among children ,18 years old with isolated linear skull fractures managed in the ED.…”

Section: What This Study Addsmentioning

confidence: 99%

Isolated Linear Skull Fractures in Children With Blunt Head Trauma

et al. 2015

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Head Trauma in Children Younger Than 2 Years

Gruskin¹,

Schutzman²

1999

Arch Pediatr Adolesc Med

110

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To determine the incidence of skull fracture (SF) and intracranial injury (ICA) among children younger than 2 years evaluated in a pediatric emergency department for head trauma; whether historical features and/or physical findings are predictive of injury type; and whether clinical criteria could allow a selective approach to radiographic imaging.Design: Retrospective medical record review.Setting: Tertiary pediatric emergency department.Patients: Case series of 278 children aged younger than 24 months evaluated for head injury.Main Outcome Measures: Presence of SF and/or ICA.Results: Diagnoses at discharge included 227 minor head injuries, 39 isolated SF, 9 ICA with SF, and 3 isolated ICA. Children younger than 12 months had the highest incidence of SF/ICA (29%) vs 4% for children aged 13 to 24 months (PϽ.001). Seven percent of complications from SF/ICA resulted from falls 3 ft (0.9 m) or less. Incidence of behavioral change, loss of consciousness, emesis, and seizures did not differ significantly between those with minor head injuries and those with SF/ICA. Scalp abnormalities were more common in children with SF/ ICA (PϽ.001). Sixty-two percent of children with isolated SF and 58% of children with ICA had no history of loss of consciousness, emesis, seizure, or behavioral change. Ninety-two percent of children with isolated SF and 75% of children with ICA had normal levels of consciousness and nonfocal neurologic examinations at diagnosis. Among children who fell 3 ft (0.9 m) or less and had no loss of consciousness, emesis, seizure, behavioral change, or scalp abnormality, none of 31 (95% confidence interval [CI], 0-0.10) children younger than 24 months and none of 20 (95% CI, 0-0.15) children younger than 12 months had SF/ICA.Conclusions: Both SF and ICA are common in children younger than 2 years evaluated for head trauma. Children younger than 12 months are at highest risk. Injuries resulted from relatively minor falls and occurred in alert, neurologically normal children. Clinical signs and symptoms were insensitive predictors of SF/ICA; however, a grouping of features (fall Յ3 ft [0.9 m], no history of neurologic symptoms, and normal scalp physical examination results) identified a subset of children at low risk for complications.

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Infants With Isolated Skull Fracture: What Are Their Clinical Characteristics, and Do They Require Hospitalization?

Cited by 87 publications

References 24 publications

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Isolated Linear Skull Fractures in Children With Blunt Head Trauma

Head Trauma in Children Younger Than 2 Years

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