Donaldson Katelyn, Li Xun, Sartorelli Kennith H, Weimersheimer Peter, Durham Susan R
Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI.
Pediatric Surgery.
Pediatr Emerg Care. 2019 Apr;35(4):301-308. doi: 10.1097/PEC.0000000000001814.
Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions.
Using PubMed and The Cochrane Library databases, a literature search using the search terms (pediatric OR child) AND skull fracture AND (isolated OR linear) was performed. Three hundred forty-three abstracts were identified and screened based on the inclusion criteria: (1) linear, nondepressed ISF; (2) no evidence of intracranial injury; (3) age 18 years or younger; and (4) data on patient outcomes and management. Data including age, Glasgow Coma Scale score on arrival, repeat imaging, admission rates, need for neurosurgical intervention, and patient outcome were collected. Two authors reviewed each study for data extraction and quality assessment.
Fourteen articles met the eligibility criteria. Data including admission rates, outcomes, and necessity of neurosurgical intervention were analyzed. Admission rates ranged from 56.8% to 100%; however, only 8 of more than 5000 patients developed new imaging findings after admission, all of which were nonsurgical. Only 1 patient required neurosurgical intervention for a finding evident upon initial evaluation.
Pediatric ISF patients with a presenting Glasgow Coma Scale score of 15 who are neurologically intact and tolerating feeds without concern for nonaccidental trauma or an unstable social environment can safely be discharged following ED evaluation to a responsible caregiver.
儿童孤立性颅骨骨折（ISF）是急诊科最常见的损伤之一。近期研究表明，这些儿童在急诊科评估后可安全出院，发生延迟性神经功能损害的风险很小。本研究的目的是提出一项基于证据的儿童ISF管理方案，以减少不必要的住院治疗。
利用PubMed和Cochrane图书馆数据库，使用检索词（儿科或儿童）、颅骨骨折和（孤立性或线性）进行文献检索。根据纳入标准对343篇摘要进行了识别和筛选：（1）线性、非凹陷性ISF；（2）无颅内损伤证据；（3）年龄18岁及以下；（4）有关患者结局和管理的数据。收集的数据包括年龄、入院时的格拉斯哥昏迷量表评分、重复影像学检查、入院率、神经外科干预需求和患者结局。两位作者对每项研究进行了数据提取和质量评估。
14篇文章符合入选标准。分析了包括入院率、结局和神经外科干预必要性在内的数据。入院率从56.8%到100%不等；然而，在5000多名患者中，只有8例在入院后出现了新的影像学发现，所有这些均无需手术治疗。只有1例患者因初始评估时明显的发现而需要神经外科干预。
格拉斯哥昏迷量表评分为15分、神经功能完好且能耐受喂养、不存在非意外伤害或社会环境不稳定问题的儿科ISF患者，在急诊科评估后可安全出院，交由责任监护人照顾。
