MANAGEMENT OF UNCOMPLICATED SKULL FRACTURES IN CHILDREN - IS HOSPITALADMISSION NECESSARY

Objective: This study was undertaken to determine the necessity for ro utine hospital admission of children with skull fractures, a normal ne urological exam, a normal head CT, and no other injuries ('uncomplicat ed skull fracture'). Methods: A prospective study of closed-head injur ies in children was done over a 2-year period at St. Louis Children's Hospital. All patients with closed head injuries underwent skull radio graphs and a head CT scan. From this cohort, children with uncomplicat ed skull fractures were identified and studied. For comparison, a retr ospective analysis was also performed of the hospital admission record s of children admitted over a 5-year period (1990-1994) with the diagn osis of epidural hematoma (EDH) to identify the typical time intervals between injury and documentation of the lesion in these cases. Result s: Forty-four patients with uncomplicated skull fractures were identif ied; all had been admitted for observation. Mean age was 1.8 years. Av erage 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 th is study group suffered a complication related to their inury. Twenty- three patients with EDH had been admitted during the fi-year review pe riod. Slightly more than one-half of patients had their EDH detected w ithin 6 h of injury. The others were diagnosed more than 6 h after inj ury due to a delay in medical evaluation or a delay in obtaining a com puted tomographic (CT) scan after an initial medical evaluation. Concl usions: Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered fo r discharge home. The definition of an uncomplicated skull fracture re quires that a head CT be performed on these patients.