{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:19:17Z","timestamp":1791379157006,"version":"4.3.2"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Children with skull fractures are often transferred to hospitals with pediatric neurosurgical capabilities. Historical data suggest that a small percentage of patients with an isolated skull fracture will clinically decline. However, recent papers have suggested that the risk of decline in certain patients is low. There are few data regarding the financial costs associated with transporting patients at low risk for requiring specialty care. In this study, the clinical outcomes and financial costs of transferring of a population of children with isolated skull fractures to a Level 1 pediatric trauma center over a 9-year period were analyzed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review of all children treated for head injury at Riley Hospital for Children (Indianapolis, Indiana) between 2005 and 2013 was performed. Patients with a skull fracture were identified based on ICD-9 codes. Patients with intracranial hematoma, brain parenchymal injury, or multisystem trauma were excluded. Children transferred to Riley Hospital from an outside facility were identified. The clinical and radiographic outcomes were recorded. A cost analysis was performed on patients who were transferred with an isolated, linear, nondisplaced skull fracture.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Between 2005 and 2013, a total of 619 pediatric patients with isolated skull fractures were transferred. Of these, 438 (70.8%) patients had a linear, nondisplaced skull fracture. Of these 438 patients, 399 (91.1%) were transferred by ambulance and 39 (8.9%) by helicopter. Based on the current ambulance and helicopter fees, a total of $1,834,727 (an average of $4188.90 per patient) was spent on transfer fees alone. No patient required neurosurgical intervention. All patients recovered with symptomatic treatment; no patient suffered late decline or epilepsy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study found that nearly $2 million was spent solely on transfer fees for 438 pediatric patients with isolated linear skull fractures over a 9-year period. All patients in this study had good clinical outcomes, and none required neurosurgical intervention. Based on these findings, the authors suggest that, in the absence of abuse, most children with isolated, linear, nondisplaced skull fractures do not require transfer to a Level 1 pediatric trauma center. The authors suggest ideas for further study to refine the protocols for determining which patients require transport.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.9.peds15352","type":"journal-article","created":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T14:58:12Z","timestamp":1451660292000},"page":"602-606","source":"Crossref","is-referenced-by-count":21,"title":["Transfer of children with isolated linear skull fractures: is it worth the cost?"],"prefix":"10.3171","volume":"17","author":[{"given":"Ian K.","family":"White","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ecaterina","family":"Pestereva","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashif A.","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Fulkerson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15352","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1007\/s00247-010-1555-4","article-title":"Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma","volume":"40","author":"Erlichman","year":"2010"},{"key":"b2-peds15352","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","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","author":"Greenes","year":"1997"},{"key":"b3-peds15352","series-title":"Arch Pediatr Adolesc Med","first-page":"15","article-title":"Head trauma in children younger than 2 years: are there predictors for complications?","volume":"153","author":"Gruskin","year":"1999"},{"key":"b4-peds15352","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jpeds.2012.06.038","article-title":"Yield of skeletal surveys in children \u2264 18 months of age presenting with isolated skull fractures","volume":"162","author":"Laskey","year":"2013"},{"key":"b5-peds15352","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","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","author":"Mannix","year":"2013"},{"key":"b6-peds15352","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1016\/j.jpedsurg.2014.09.038","article-title":"Impact of newly adopted guidelines for management of children with isolated skull fracture","volume":"49","author":"Metzger","year":"2014"},{"key":"b7-peds15352","series-title":"Clin Pediatr (Phila)","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1177\/0009922812446009","article-title":"Nondepressed linear skull fractures in children younger than 2 years: is computed tomography always necessary?","volume":"51","author":"Reid","year":"2012"},{"key":"b8-peds15352","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","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","author":"Rollins","year":"2011"},{"key":"b9-peds15352","series-title":"Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","article-title":"Common injuries that result in hospitalization, 2004: Statistical Brief #19","author":"Russo","year":"2006"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/17\/5\/article-p602.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/17\/5\/article-p602.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/17\/5\/article-p602.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:24:01Z","timestamp":1681565041000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/17\/5\/article-p602.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5]]},"references-count":9,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2015.9.peds15352","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5]]}}}