Vogelbaum M A, Kaufman B A, Park T S, Winthrop A L
Department of Neurological Surgery, Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, MO, USA.
Pediatr Neurosurg. 1998 Aug;29(2):96-101. doi: 10.1159/000028697.
This study was undertaken to determine the necessity for routine hospital admission of children with skull fractures, a normal neurological exam, a normal head CT, and no other injuries ('uncomplicated skull fracture').
A prospective study of closed-head injuries in children was done over a 2-year period at St. Louis Children's Hospital. All patients with closed head injuries underwent skull radiographs and a head CT scan. From this cohort, children with uncomplicated skull fractures were identified and studied. For comparison, a retrospective analysis was also performed of the hospital admission records of children admitted over a 5-year period (1990-1994) with the diagnosis of epidural hematoma (EDH) to identify the typical time intervals between injury and documentation of the lesion in these cases.
Forty-four patients with uncomplicated skull fractures were identified; all had been admitted for observation. Mean age was 1.8 years. Average time between injury and hospital admission was 6.35 h with half of this time being spent in the emergency room. Average LOS was 35 h, but 50% of patients were hospitalized less than 24 h. No patient in this study group suffered a complication related to their inury. Twenty-three patients with EDH had been admitted during the 5-year review period. Slightly more than one-half of patients had their EDH detected within 6 h of injury. The others were diagnosed more than 6 h after injury due to a delay in medical evaluation or a delay in obtaining a computed tomographic (CT) scan after an initial medical evaluation.
Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered for discharge home. The definition of an uncomplicated skull fracture requires that a head CT be performed on these patients.
本研究旨在确定对于颅骨骨折、神经系统检查正常、头颅CT正常且无其他损伤（“单纯性颅骨骨折”）的儿童进行常规住院治疗的必要性。
在圣路易斯儿童医院对儿童闭合性颅脑损伤进行了为期2年的前瞻性研究。所有闭合性颅脑损伤患者均接受了颅骨X线检查和头颅CT扫描。从该队列中识别并研究了单纯性颅骨骨折的儿童。为作比较，还对5年期间（1990 - 1994年）因硬膜外血肿（EDH）诊断入院的儿童的住院记录进行了回顾性分析，以确定这些病例中损伤与病变记录之间的典型时间间隔。
识别出44例单纯性颅骨骨折患者；所有患者均入院观察。平均年龄为1.8岁。损伤至入院的平均时间为6.35小时，其中一半时间花费在急诊室。平均住院时间为35小时，但50%的患者住院时间少于24小时。该研究组中无患者因损伤出现并发症。在5年回顾期内有23例EDH患者入院。略多于一半的患者在损伤后6小时内发现EDH。其他患者因医学评估延迟或初始医学评估后获取计算机断层扫描（CT）扫描延迟而在损伤后6小时以上被诊断。
对于单纯性颅骨骨折患者，在无反复呕吐和/或虐待儿童证据的情况下，可考虑出院回家。单纯性颅骨骨折的定义要求对这些患者进行头颅CT检查。
