Authors: Weston Northam, MD; Andrew Abumoussa, MD; Avinash Chandran, PhD; Scott Elton, MD; Carolyn Quinsey, MD (Chapel Hill, NC)
Introduction: Skull fractures represent a common source of morbidity in the pediatric trauma population. With wide clinical variability, there is sparse evidence characterizing the type of follow up these patients receive as well as predictive factors for follow up.
Methods: This study reviews non-operative pediatric skull fractures at a single academic hospital between 2007 and 2017. Clinical patient and radiographic fracture characteristics were recorded. Neurosurgical recommended follow up, follow up appointments, imaging studies, and fracture-related complications were recorded. Statistical analyses were performed to identify predictors for outpatient follow-up and imaging.
Results: The study included 414 total patients, 37.2% female, mean age 5.2 years, with median length-of-stay 1 day (IQR 0.9 – 4). Over 438 clinic visits, and median follow-up of 8 weeks (IQR 4-12, range 1-144), 231 imaging studies were performed, mostly head CT (55%). A total of 283 patients were recommended follow-up in clinic, and 86% were seen. Only 12 complications were detected, including 7 growing skull fractures, 2 traumatic encephaloceles, and 3 patients with hearing loss. Patients were significantly (p<0.05) more likely to receive follow up if they had insurance, PCP, neurologic deficit, intracranial hemorrhage, pneumocephalus, or bilateral fracture. Similarly, outpatient imaging was significantly (p<0.05) associated with insurance, PCP, intracranial hemorrhage, and bilateral fracture. No complications were found in patients with linear fractures above the skull base without intracranial hemorrhage.
Conclusion: Pediatric non-operative skull fractures drive a large expenditure of clinic and imaging resources to detect a small profile of complications. Understanding the factors underlying the decision for clinic follow-up and additional imaging can decrease future cost and radiation exposure. Socio-economic status (PCP and insurance) may affect access to appropriate neurosurgical follow-up and deserves future research attention.