Pediatric basilar skull fracture: do children with normal neurologic findings and no intracranial injury require hospitalization?

STUDY OBJECTIVE

To delineate complications in patients with basilar skull fractures (BSFs) and normal neurologic findings, including computed tomography (CT) scans without intracranial injury, and to assess the need for hospitalization.

DESIGN

Retrospective chart review.

PARTICIPANTS

All emergency department patients with the ED diagnosis or hospital discharge diagnosis of BSF. Patients were included if they had a clinical or radiographic diagnosis of BSF. A subgroup of patients ("simple BSF") with normal neurologic examination findings in the ED, Glasgow Coma Scale scores of 15, and cranial CT scans without intracranial pathology was specifically analyzed.

RESULTS

We included 239 patients in the study. One hundred fourteen patients (48%) were included in the "simple BSF" subgroup. In this subgroup, vomiting (6%) was the most common complication, meningitis (1%) the most serious. There were no cases of delayed intracranial hemorrhage, and no patient with "simple BSF" required surgery.

CONCLUSION

Given the relatively low frequency of serious complications, our study suggests that some patients with BSFs may not require hospital admission.