{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:46:17Z","timestamp":1788453977105,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T00:00:00Z","timestamp":1505692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13\u201315) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009\u20132014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with <jats:italic>P<\/jats:italic> value &lt;0.05 considered significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four hundred and ten children were analysed. Three hundred and eighty\u2010one (93%) children were managed conservatively, 18 (4%) underwent evacuation of extradural haematoma (<jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> surgery) and 11 (3%) needed fracture repair surgery. Two children evolved a surgical lesion 24 h post\u2010admission. Only 17 of 214 children transferred from peripheral hospitals needed neurosurgery. Overall outcomes: zero deaths, one needed brain injury rehabilitation and 63 needed child protection unit intervention. Seventy\u2010five percentage of children with non\u2010surgical lesions were discharged within 2 days. Eighty\u2010three percentage of road transfers were discharged within 3 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Children with small intracranial haematomas and\/or skull fractures who need no surgery only require brief inpatient symptomatic treatment and could be safely managed in primary hospitals. Improved tertiary hospital transfer guidelines with protocols to manage clinical deterioration could have cost benefit without risking patient safety.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.14175","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T23:50:38Z","timestamp":1505778638000},"page":"202-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3144-3168","authenticated-orcid":false,"given":"Krishna","family":"Tallapragada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Children's Hospital Westmead, NSW Health  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratna Soundarya","family":"Peddada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Children's Hospital Westmead, NSW Health  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Dexter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Children's Hospital, Westmead Public and Private Hospitals  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,18]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"457","article-title":"Pediatric traumatic brain injury","volume":"68","author":"Schaller AL","year":"2015","journal-title":"S. 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