Evaluation of a Management Algorithm for Pediatric Isolated Skull Fractures

Medical decision-making for pediatric patients with isolated skull fracture (ISF) is highly variable. A study conducted at Primary Children’s Medical Center (PCMC) found that neurologically normal patients with ISF generally have a good neurologic outcome, but still were typically admitted to the hospital. These potentially unnecessary hospital admissions result in additional costs, utilization of hospital resources, and further strain on families. Recently, a management algorithm was implemented to attempt to reduce unnecessary hospital admissions, and provide guidelines for clinicians. The current study aims to evaluate the impact of this algorithm on management decisions for these patients. Patients were prospectively enrolled, and telephone interviews were conducted 24-48 hours after leaving the emergency department (ED). Thus far, our study has enrolled 18 patients aged 25 days to 9 years (median =8 months), with falls being the most common cause of injury (83%). Of this cohort, 12 (66.7%) were admitted. The most common stated reason for admission was patient age (being less than 2 years; 45.5%). There was no difference in the rate of symptoms experienced while in the ED between the admitted and ED-discharged patients. Of the 5 ED-discharged patient with follow-up completed, 3 had return of symptoms, though none had returned to medical care. These preliminary results suggest that implementation of the management algorithm has not substantially reduced the rate of admissions for ISF patients compared to the prior rate (75%), and that age continues to be a major consideration for clinicians when considering admission for pediatric ISF patients.