Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
J Pediatr Surg. 2011 Jul;46(7):1342-6. doi: 10.1016/j.jpedsurg.2010.12.019.
The management of children presenting with an isolated skull fracture (ISF) posttrauma is highly variable. We sought to estimate the risk of neurologic deterioration in children with a Glasgow coma score (GCS) 15 and ISF to reduce unnecessary hospital admissions.
A retrospective review at a level I pediatric trauma referral center was conducted for patients with ISF on head computed tomography from 2003 to 2008. Patients were excluded for injury greater than 24 hours prior, GCS less than 15, intracranial pathology, significant fracture depression, or complex fractures involving facial bones or skull base.
A total of 235 patients were identified with an ISF. The median age was 11 months, with falls accounting for 87% of the injuries. One hundred seventy-seven patients were admitted, and 58 patients were discharged from the emergency department after a period of observation (median, 3.3 hours). Median length of stay for those admitted to the hospital was 18.2 hours. One patient developed vomiting following overnight observation and a repeat computed tomography scan demonstrated a small extra-axial hematoma that required no intervention. The mean total costs for patients discharged from the emergency department were $291 vs $1447 for those admitted for observation (P < .001).
Patients with a presenting GCS of 15 and an ISF can be safely discharged from the emergency department after a short period of observation if they are asymptomatic and have a reliable social environment. This could result in significant savings by eliminating inpatient costs.
创伤后出现单纯性颅骨骨折（ISF）患儿的管理方式存在较大差异。我们旨在评估格拉斯哥昏迷评分（GCS）为 15 分且伴有 ISF 的患儿发生神经功能恶化的风险，以减少不必要的住院。
对 2003 年至 2008 年期间因头部 CT 检查发现 ISF 而在一级儿科创伤转诊中心就诊的患儿进行回顾性研究。排除伤后时间大于 24 小时、GCS 评分小于 15 分、颅内病变、明显凹陷性骨折或累及面骨或颅底的复杂骨折的患儿。
共确定 235 例 ISF 患儿。中位年龄为 11 个月，87%的损伤由跌倒引起。177 例患儿入院，58 例患儿在急诊科观察（中位时间为 3.3 小时）后出院。入院患儿的中位住院时间为 18.2 小时。1 例患儿在夜间观察后出现呕吐，再次行 CT 扫描显示小的硬膜外血肿，无需干预。从急诊科出院的患儿平均总费用为 291 美元，而留观患儿的平均总费用为 1447 美元（P<0.001）。
如果患儿在就诊时 GCS 评分为 15 分，且 ISF 患儿无症状且具有可靠的社会环境，可在短时间观察后安全从急诊科出院。这可通过消除住院费用而显著节省费用。
