Authors: Alan Tang; Rebecca Reynolds, MD; E. Haley Vance; Chris Bonfield, MD; Chevis Shannon, MBA, MPH, DrPH (Nashville, TN)

Introduction:

Pediatric isolated linear skull fractures commonly result from head trauma and rarely require surgery; however, patients with these injuries are often admitted to the hospital for observation. Some hospitals have developed protocols to decrease unnecessary admissions. In this study, we utilized a large database to investigate admission trends nationwide.

Methods:

Our study included children under 18 years old with isolated linear skull fractures from the Healthcare and Utilization Project (HCUP) Kids' Inpatient Database presenting between 2001 and 2012. Data was collected in three-year increments (2001-2003, 2004-2006, 2007-2009, and 2010-2012). Children with depressed skull fractures, multiple traumatic injuries, and intracranial hemorrhage were excluded. Sample-level data was translated into population-level data using HCUP-specific discount weights.

Results:

There were 11,093 patients (63% males) admitted to 1,417 hospitals between 2001 and 2012. National admissions decreased over time, from 1,201 patients in 2001 to 739 in 2012. Average admission age decreased from 7.4 years to 4.9 years (p < 0.001). Admission was higher in June, July, and August compared to other months and was likelier to occur on weekdays (67%) than weekends (p = 0.024). Average length-of-stay decreased from 2001 (2.23 days) to 2006 (1.54 days), before plateauing from 2007 to 2012. Adjusted for inflation, mean total hospital charges decreased from $15,351 to $13,955 (p < 0.001). The highest admission count came from the South (35%), while the Northeast carried the lowest (16%). Smaller hospitals admitted fewer patients (15% to 10%; p < 0.001), while larger hospitals admitted more (60% to 72%; p < 0.001). Overall, admissions dropped by 4% in rural hospitals and increased by 9% at urban centers (p < 0.001).  

Conclusion:

This study identified a general decrease nationwide in pediatric linear isolated skull fracture admissions and costs associated with admission. Admissions shifted from smaller, rural hospitals to larger, urban teaching hospitals.