{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:38:22Z","timestamp":1783777102370,"version":"3.55.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)\u2013based disposition scenarios for a pediatric patient presenting with ISF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization. Current rates of admission, deterioration after initial diagnosis, and ED return after discharge, as well as cost of observation-only status, were obtained through literature review. Cost calculations using Healthcare Cost and Utilization Project data included total ED cost, admission without complication, and admission with deterioration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In current practice, 76% of subjects with ISF are admitted and 2.5% of those develop persistent or new symptoms. No patient diagnosed with ISF required neurosurgical intervention. Of those discharged home from the ED, 2.8% return with a new concern with 7.4% having new findings on imaging leading to admission. Total cost per 100 patients by current practice was US $583,587. Increasing at-home surveillance by 20% resulted in a total cost saving of US $113,176 per 100 patients while increasing returns to the ED from less than 1% to 1.1%. Admitting at the current rate to an observation unit resulted in a US $205,395 cost saving per 100 patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Decreased inpatient utilization through home surveillance or observation unit use reduced cost associated with pediatric ISF management without increasing clinical risk owing to the low probability of clinical deterioration after initial diagnosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001324","type":"journal-article","created":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T20:27:09Z","timestamp":1511296029000},"page":"403-408","source":"Crossref","is-referenced-by-count":4,"title":["Management of Pediatric Isolated Skull Fractures"],"prefix":"10.1097","volume":"34","author":[{"given":"Daniel C.","family":"Williams","sequence":"first","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Scott","family":"Russell","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie L.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kit N.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Health Science and Research, Medical University of South Carolina, Charleston, SC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Basco","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Teufel","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230930","first-page":"15","article-title":"Head trauma in children younger than 2 years: are there predictors for complications?","volume":"153","year":"1999","journal-title":"Arch Pediatr Adolesc Med"},{"key":"bib2-20230930","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00001199-200505000-00006","article-title":"The incidence of traumatic brain injury among children in the United States: differences by race","volume":"20","year":"2005","journal-title":"J Head Trauma Rehabil"},{"key":"bib3-20230930","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1542\/peds.107.5.983","article-title":"Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines","volume":"107","year":"2001","journal-title":"Pediatrics"},{"key":"bib4-20230930","doi-asserted-by":"crossref","first-page":"e851","DOI":"10.1542\/peds.2014-2858","article-title":"Isolated linear skull fractures in children with blunt head trauma","volume":"135","year":"2015","journal-title":"Pediatrics"},{"key":"bib5-20230930","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.annemergmed.2013.02.027","article-title":"Isolated skull fractures: trends in management in US pediatric emergency departments","volume":"62","year":"2013","journal-title":"Ann Emerg Med"},{"key":"bib6-20230930","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.jpedsurg.2010.12.019","article-title":"Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation","volume":"46","year":"2011","journal-title":"J Pediatr Surg"},{"key":"bib7-20230930","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000092355","article-title":"Evaluation of mild head injury in a pediatric population","volume":"42","year":"2006","journal-title":"Pediatr Neurosurg"},{"key":"bib8-20230930","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1001\/archpediatrics.2011.1156","article-title":"Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms","volume":"166","year":"2012","journal-title":"Arch Pediatr Adolesc Med"},{"key":"bib9-20230930","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0196-0644(97)70158-6","article-title":"Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization?","volume":"30","year":"1997","journal-title":"Ann Emerg Med"},{"issue":"suppl","key":"bib10-20230930","first-page":"1","article-title":"ICD-9-CM. 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