Arrey Eliel N, Kerr Marcia L, Fletcher Stephen, Cox Charles S, Sandberg David I
Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children's Memorial Hermann Hospital, Houston, Texas.
J Neurosurg Pediatr. 2015 Dec;16(6):703-8. doi: 10.3171/2015.4.PEDS1545. Epub 2015 Sep 4.
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.
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.
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.
Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.
在本研究中，作者回顾了一大系列孤立性线性非移位颅骨骨折（NDSF）患儿的临床管理及治疗结果。还回顾了与这些患者住院相关的因素及管理成本。
经机构审查委员会批准后，作者回顾性分析了2009年1月至2013年12月期间在一家儿童医院接受NDSF评估的0至16岁患者的临床记录和影像学研究。若骨折为开放性或粉碎性，则将患者排除。其他排除标准包括颅内出血、多处颅骨骨折或气颅。
326例患者符合纳入标准。患者的中位年龄为19个月（范围为2周至15岁）。193例（59%）为男性，133例（41%）为女性。184例（56%）患者接受23小时观察处理，87例（27%）入院治疗，55例（17%）患者从急诊科出院。278例（85%）乘救护车前来，36例（11%）乘汽车前来，12例（4%）由直升机空运而来。257例（79%）患者从其他机构转诊而来。入院患者的平均住院时间为46小时（范围为7至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（范围为2至43小时）。住院时间超过1天的原因包括儿童保护服务机构介入24例患者，以及其他损伤11例患者。13%（n = 45）患者有精神状态改变或意识丧失史。检查时无患者有任何神经功能缺损，且无人需要神经外科干预。不到16%（n = 50）患者随后进行了门诊随访。这些患者在随访时神经功能均完好。
许多NDSF患儿无需住院治疗。有精神状态改变、其他损伤或可能存在非意外伤害的患者可能需要观察。
