Metzger Ryan R, Smith Julia, Wells Matthew, Eldridge Lesley, Holsti Maija, Scaife Eric R, Barnhart Douglas C, Rollins Michael D
Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
Trauma Service, Primary Children's Hospital, Salt Lake City, Utah.
J Pediatr Surg. 2014 Dec;49(12):1856-60. doi: 10.1016/j.jpedsurg.2014.09.038. Epub 2014 Oct 1.
In an effort to standardize practices and reduce unnecessary hospital resource utilization, we implemented guidelines for management of patients with isolated skull fractures (ISF). We sought to examine the impact of these guidelines.
Patients with nondisplaced/depressed fracture of the skull vault without intracranial hemorrhage were prospectively enrolled from February 2010 to February 2014.
Eighty-eight patients (median age=10months) were enrolled. Fall was the most common mechanism of injury (87%). The overall admission rate was 57%, representing an 18% decrease from that reported prior to guideline implementation (2003-2008; p=0.001). Guideline criteria for admission included vomiting, abnormal neurologic exam, concern for abuse, and others. Forty-two percent of patients were admitted outside of the guideline, primarily because of young age (20%). Patients transferred from another hospital (36%) were more likely to be admitted, though the majority (63%) did not meet admission criteria. No ED-discharged patient returned for neurologic symptoms, and none reported significant ongoing symptoms on follow-up phone call.
Implementation of a new guideline for management of ISF resulted in a reduction of admissions without compromising patient safety. Young age remains a common concern for practitioners despite not being a criterion for admission. Interhospital transfer may be unnecessary in many cases.
为规范治疗方法并减少不必要的医院资源利用，我们实施了单纯颅骨骨折（ISF）患者的管理指南。我们试图研究这些指南的影响。
2010年2月至2014年2月前瞻性纳入无颅内出血的非移位/凹陷性颅骨穹窿骨折患者。
纳入88例患者（中位年龄=10个月）。跌倒为最常见的受伤机制（87%）。总体入院率为57%，较指南实施前（2003 - 2008年）报告的入院率下降了18%（p = 0.001）。入院的指南标准包括呕吐、神经系统检查异常、怀疑虐待及其他。42%的患者在指南规定范围之外入院，主要原因是年龄小（20%）。从其他医院转诊来的患者（36%）更有可能入院，尽管大多数（63%）不符合入院标准。没有因急诊出院的患者因神经系统症状返回，且在随访电话中无人报告有明显持续症状。
实施新的ISF管理指南导致入院人数减少，且未损害患者安全。尽管年龄小并非入院标准，但仍是从业者普遍关注的问题。在许多情况下，院际转诊可能不必要。
