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Isolated Skull Fracture – What to Do

December 14, 2017

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Children with isolated, non-depressed skull fracture did extremely well.  Of 6646 children in this systematic review, none died and only one progressed to need neurosurgical intervention.

Why does this matter?
Children with isolated non-depressed skull fracture are admitted for observation 80% of the time and many receive repeat imaging.  The overwhelming majority do well.  This review pooled multiple studies to get a big picture view of the problem.

Jack fell down and broke his crown
This was a systematic review of 21 studies, including 6646 children with isolated linear, non-depressed skull fracture.  No children in this cohort died.  One needed neurosurgery (cerebral meninges repair on day of admission).  569 had repeat neuroimaging; 6 had new hemorrhage detected but none required intervention.  Most of the included studies were retrospective and relied on discharge diagnosis code, which could have missed some children with complications.  Overall, in a highly select group of children with this type of injury pattern, barring other reasons for admission or concern for non-accidental trauma, it appears safe to manage them on an outpatient basis.

A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children.  Ann Emerg Med. 2017 Nov 23. pii: S0196-0644(17)31797-3. doi: 10.1016/j.annemergmed.2017.10.014. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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