TY - JOUR
T1 - Natural history and clinical implications of nondepressed skull fracture in young children
AU - Hassan, Saif F.
AU - Cohn, Stephen M.
AU - Admire, John
AU - Nunez-Cantu, Olliver
AU - Arar, Yousef
AU - Myers, John G.
AU - Dent, Daniel L.
AU - Eastridge, Brian J.
AU - Cestero, Ramon F.
AU - Gunst, Mark
AU - Markowski, Helen
AU - Keric, Natasha
AU - Liao, Lillian
AU - Mueller, Deborah L.
PY - 2014/7
Y1 - 2014/7
N2 - Background: Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes. Methods: Medical records were reviewed for all children 5 years or younger with SFs who presented to our Level I trauma center during a 4-year period. Data collected included patient demographics, Glasgow Coma Scale (GCS) score at admission, level of consciousness at the time of injury, type of SF (depressed SF vs. NDSF), magnitude of the SF depression, evidence of neurologic deficit, and the requirement for neurosurgical intervention. Results: We evaluated 1,546 injured young children during the study period. From this cohort, 563 had isolated head injury, and 223 of them had SF. Of the SF group, 163 (73%) had NDSFs, of whom 128 (78%) presented with a GCS score of 15. None of the NDSF patients with a GCS score of 15 required neurosurgical intervention or developed any neurologic deficit. Of the remaining 35 patients with NDSF and GCS score less than 15, 7 (20%) had a temporary neurologic deficit that resolved before discharge, 4 (11%) developed a persistent neurologic deficit, and 2 died (6%). Conclusion: Children 5 years or younger with NDSFs and a normal neurologic examination result at admission do not develop neurologic deterioration.
AB - Background: Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes. Methods: Medical records were reviewed for all children 5 years or younger with SFs who presented to our Level I trauma center during a 4-year period. Data collected included patient demographics, Glasgow Coma Scale (GCS) score at admission, level of consciousness at the time of injury, type of SF (depressed SF vs. NDSF), magnitude of the SF depression, evidence of neurologic deficit, and the requirement for neurosurgical intervention. Results: We evaluated 1,546 injured young children during the study period. From this cohort, 563 had isolated head injury, and 223 of them had SF. Of the SF group, 163 (73%) had NDSFs, of whom 128 (78%) presented with a GCS score of 15. None of the NDSF patients with a GCS score of 15 required neurosurgical intervention or developed any neurologic deficit. Of the remaining 35 patients with NDSF and GCS score less than 15, 7 (20%) had a temporary neurologic deficit that resolved before discharge, 4 (11%) developed a persistent neurologic deficit, and 2 died (6%). Conclusion: Children 5 years or younger with NDSFs and a normal neurologic examination result at admission do not develop neurologic deterioration.
KW - Depressed skull fractures
KW - Glasgow Coma Scale
KW - neurologic deficit
KW - neurosurgical intervention
KW - nondepressed skull fractures
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U2 - 10.1097/TA.0000000000000256
DO - 10.1097/TA.0000000000000256
M3 - Article
C2 - 24977773
AN - SCOPUS:84903772652
SN - 2163-0755
VL - 77
SP - 166
EP - 169
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -