Nav: Home

Study: Children with simple skull fractures may not need hospitalization

March 24, 2016

Challenging the longstanding practice of keeping all children with head injuries in the hospital overnight, new research from Ann & Robert H. Lurie Children's Hospital suggests that patients with simple skull fractures can be sent home safely if they have no evidence of brain injury and no neurologic symptoms.

The results, published in the April issue of the Journal of Pediatric Surgery, call into question the wisdom and practicality of keeping such low-risk patients hospitalized overnight.

If reaffirmed in larger studies, the findings can pave the way toward ending a pervasive practice that may be both unnecessary and costly, the researchers say.

The analysis, based on a review of records of patients with simple skull fractures treated at Lurie Children's over a decade, revealed that more than three-quarters were admitted to the hospital for overnight observation, incurring thousands of dollars in additional costs. Yet, none of those admitted for overnight stay had any complications or needed additional imaging or tests.

"These 'just in case' overnight stays appear to be not only unwarranted and wasteful, but can be disruptive for the family and traumatic for the child," says lead investigator Catherine Hunter, M.D., a pediatric surgeon at Lurie Children's and assistant professor of surgery at Northwestern University Feinberg School of Medicine. "Reducing the number of unnecessary hospitalizations can help generate substantial savings to individual patients and the healthcare system as a whole."

Nearly half a million U.S. children are seen in emergency rooms every year for suspected traumatic head injuries. While a portion of patients who end up in the emergency room with head trauma are seriously injured, researchers say, many have minor, uncomplicated injuries that may need nothing more than a thorough neurologic exam to rule out more serious brain trauma. Despite evidence showing that children with minor head injuries and normal neurologic exams are at very low risk for complications, keeping all children with head injuries in the hospital for observation has remained a widespread practice.

"Our findings underscore the notion that not all head injuries are the same, and that kids with isolated skull fractures and no other symptoms may be perfectly safe going home," says Rashmi Kabre, M.D., co-author on the paper and director of pediatric trauma at Lurie Children's.

For their study, researchers analyzed data obtained from records of 71 children treated at Lurie Children's for uncomplicated head injuries over 10 years. Of the 71 children treated in the emergency room, 78 percent were kept for overnight observation. None required additional imaging or treatment. All fared well and were sent home the next day. On average, a child's overnight stay incurred an additional $4,291 in hospital costs.

The research team emphasizes that their analysis purposefully excluded children with serious head traumas, loss of consciousness and brain bleeding. Such children are deemed high risk and must be kept in the hospital for further testing and observation. The analysis focused exclusively on children with normal exams and no signs of neurologic damage such as confusion, severe headache, vomiting, seizures or dizziness, all of which can signal serious brain injury.

In an era of greater financial accountability, reducing the number of unnecessary hospitalizations could generate substantial savings to consumers and the healthcare system, the researchers say.

However, the team cautions, any cases of isolated fractures that suggest non-accidental trauma or intentional injury, such as child abuse, require further evaluation and overnight observation, even if the child is neurologically intact.
-end-
Other investigators on the study included Brian Blackwood, MD, Jonathan Bean, MD, and Corinne Sadecki-Lund, RN, of Lurie Children's; and Irene Helenowski, PhD, of Northwestern University.

Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. In partnership with Northwestern University Feinberg School of Medicine, our scientists work in labs, in clinics, at the patient bedside and in the community to unravel the root causes of pediatric and adolescent disease, to understand childhood injury and to find factors that precipitate health problems in childhood and over a lifetime. Our researchers work every day to develop new therapies and prevention strategies.

Ann & Robert H. Lurie Children's Hospital of Chicago

Related Brain Injury Articles:

Brain injury causes impulse control problems in rats
New research from the University of British Columbia confirms for the first time that even mild brain injury can result in impulse control problems in rats.
Which kids will take longer to recover from brain injury?
A new biomarker may help predict which children will take longer to recover from a traumatic brain injury (TBI), according to a preliminary study published in the March 15, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology.
Researchers identify how inflammation spreads through the brain after injury
Researchers have identified a new mechanism by which inflammation can spread throughout the brain after injury.
New test may quickly identify mild traumatic brain injury with underlying brain damage
A new test using peripheral vision reaction time could lead to earlier diagnosis and more effective treatment of mild traumatic brain injury, often referred to as a concussion.
Therapy for abnormal heartbeats may cause brain injury
A common treatment for irregular heartbeats known as catheter ablation may result in the formation of brain lesions when it is performed on the left side of the heart, according to new research at UC San Francisco.
How brain tissue recovers after injury
A Kobe University research team has pinpointed the mechanism underlying astrocyte-mediated restoration of brain tissue after an injury.
Depression in soldiers linked to brain disruption from injury
Using multiple brain imaging techniques, researchers have found that a disruption of the circuitry in the brain's cognitive-emotional pathways may provide a physical foundation for depression symptoms in some service members who have suffered mild traumatic brain injury in combat.
Research finds brain changes, needs to be retrained after ACL injury
A new study shows that when you injure your knee, it changes your brain -- which could put you at risk for further injuries.
The effectiveness of treatment for individuals with brain injury or stroke
In the current issue of NeuroRehabilitation leading researchers explore the effectiveness of several neurorehabilitation treatments for individuals with brain injury or stroke.
Allen Institute releases powerful new data on the aging brain and traumatic brain injury
The Allen Institute for Brain Science has announced major updates to its online resources available at brain-map.org, including a new resource on Aging, Dementia and Traumatic Brain Injury in collaboration with UW Medicine researchers at the University of Washington, and Group Health.

Related Brain Injury Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...