Najmi Vesta S, Yellamraju Sivasri Krishna, Toman Emma, Elmaghraby Mostafa, Lo William, Gallo Pasquale, Solanki Guirish, Rodrigues Desiderio, Afshari Fardad T, Pepper Joshua
Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Br J Neurosurg. 2024 Oct 31:1-4. doi: 10.1080/02688697.2024.2418498.
National Institute of Clinical Excellence (NICE) guidelines advise that paediatric patients with linear skull fractures do not require admission in the absence of intracranial injury. Despite this, a period of inpatient neuro-observation has become the standard advice and practice in the UK for fear of deterioration. Our experience is that these children rarely deteriorate or require neurosurgical intervention. The primary aim of this study was to describe the incidence of neurological deterioration in patients referred to our paediatric neurosurgery unit with linear skull fractures.
We identified all patients with a linear skull fracture referred to neurosurgery at a paediatric major trauma centre between 2018 and 2023. Patients with intracranial injury, skull base fracture or major trauma were excluded. Demographic and clinical data were collected. The primary outcome was deterioration which was defined as drop in Glasgow Coma Scale (GCS) score, unplanned repeat cranial imaging, neurosurgical intervention performed, or the patient died.
Two hundred and ninety-four patients were identified in our referral database. Infants were the age group most commonly referred (44.2%) and falls from under 2 m in height the most common mechanism of injury (71.4%). Ninety-seven children had specific advice documented regarding neuro-observation; of these, the majority ( = 53) were advised 24 hours of inpatient observation. No patients experienced deterioration.
This is the largest cohort of linear skull fractures in children described in the UK. None of our patients experienced neurological deterioration, mirroring findings from international studies and supporting current NICE guidance. In addition, at a cost of £360 per 24-hour admission, this has a cost implication for a resource-scarce NHS. We propose that UK trauma networks should devise protocols to support the safe discharge from ED of such patients without the need for discussion with a neurosurgical department.
英国国家临床优化研究所（NICE）指南建议，单纯线性颅骨骨折的儿科患者若不存在颅内损伤则无需住院。尽管如此，由于担心病情恶化，住院进行神经观察已成为英国的标准建议和做法。我们的经验是，这些儿童很少出现病情恶化或需要神经外科干预。本研究的主要目的是描述转诊至我们儿科神经外科病房的线性颅骨骨折患者中神经功能恶化的发生率。
我们确定了2018年至2023年间在一家儿科重大创伤中心转诊至神经外科的所有线性颅骨骨折患者。排除有颅内损伤、颅底骨折或重大创伤的患者。收集人口统计学和临床数据。主要结局为病情恶化，定义为格拉斯哥昏迷量表（GCS）评分下降、计划外重复头颅成像、进行神经外科干预或患者死亡。
我们的转诊数据库中识别出294例患者。婴儿是最常转诊的年龄组（44.2%），从2米以下高度跌落是最常见的受伤机制（71.4%）。97名儿童有关于神经观察的具体建议记录；其中，大多数（n = 53）被建议住院观察24小时。没有患者出现病情恶化。
这是英国描述的最大一组儿童线性颅骨骨折病例。我们的患者均未出现神经功能恶化，这与国际研究结果一致，并支持当前的NICE指南。此外，每次24小时住院费用为360英镑，这对资源稀缺的英国国民医疗服务体系（NHS）来说有成本影响。我们建议英国创伤网络应制定方案，支持此类患者从急诊科安全出院，而无需与神经外科部门进行讨论。
