{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T11:41:50Z","timestamp":1771069310180,"version":"3.50.1"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children\u2019s hospital between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36 (11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7\u2013395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2\u201343 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.4.peds1545","type":"journal-article","created":{"date-parts":[[2015,9,4]],"date-time":"2015-09-04T13:59:09Z","timestamp":1441375149000},"page":"703-708","source":"Crossref","is-referenced-by-count":31,"title":["Linear nondisplaced skull fractures in children: who should be observed or admitted?"],"prefix":"10.3171","volume":"16","author":[{"given":"Eliel N.","family":"Arrey","sequence":"first","affiliation":[{"name":"Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children\u2019s Memorial Hermann Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcia L.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children\u2019s Memorial Hermann Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children\u2019s Memorial Hermann Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles S.","family":"Cox","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston Medical School, and Children\u2019s Memorial Hermann Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David I.","family":"Sandberg","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Surgery and Neurosurgery, The University of Texas Health Science Center at Houston 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