Linear nondisplaced skull fractures in children: who should be observed or admitted?
Linear nondisplaced skull fractures in children: who should be observed or admitted?
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DOI：
10.3171/2015.4.peds1545
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发表时间：
2015-12-01
影响因子：
1.9
通讯作者：
Sandberg, David I.
中科院分区：
文献类型：
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作者：
Arrey, Eliel N.;Kerr, Marcia L.;Sandberg, David I.
目的：在这项研究中，作者回顾了大量孤立性线性非移位性颅骨骨折（NDSF）儿童的临床治疗和结局。与这些患者的住院治疗和管理成本的相关因素也reviewed.METHODS机构审查委员会批准后，作者回顾性审查了临床记录和影像学研究的患者年龄在0至16岁之间，在一个单一的儿童医院评估NDSF在2009年1月至2013年12月。如果骨折为开放性或粉碎性，则排除患者。额外的排除标准包括颅内出血，超过1个颅骨骨折，或积气。中位患者年龄为19个月（范围2周至15岁）。193例患者（59%）为男性，133例（41%）为女性。184例患者（56%）接受了23小时观察，87例（27%）住院，55例（17%）从急诊科出院。278名患者（85%）乘坐救护车抵达，36名（11%）乘坐汽车抵达，12名（4%）乘坐直升机空运。257例患者（79%）从另一家机构转移。入院患者的平均住院时间为46小时（范围7-395小时）。处于23小时观察状态的患者的平均住院时间为18小时（范围2-43小时）。住院时间超过1天的原因包括24名患者涉及儿童保护服务，11名患者受到其他伤害。13%（n = 45）有精神状态改变或意识丧失的历史。没有患者在检查时有任何神经功能缺损，也没有患者需要神经外科干预。不到16%（n = 50）的患者接受了后续门诊随访。这些患者在随访时神经功能均完好无损。结论：对于许多患有NDSF的儿童来说，住院治疗是没有必要的。患者的精神状态变化，额外的伤害，或可能的非意外伤害可能需要观察。
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 between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus.RESULTS Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36(11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7-395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2-43 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit.CONCLUSIONS Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.