Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study

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  • 1 Divisions of Pediatric Critical Care and
  • 8 Pediatric Surgery, Rady Children’s Hospital, San Diego, California;
  • 2 Division of Pediatric Neurosurgery, Wolfson Children’s Hospital, Jacksonville;
  • 3 University of Florida Health, Jacksonville, Florida;
  • 4 Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children’s National Medical Center, Washington, DC;
  • 5 Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • 6 Department of Surgery, Children’s Hospital of Los Angeles, Keck School of Medicine, Los Angeles, California; and
  • 7 Department of Surgery, Mary Bridge Children’s Hospital, Tacoma, Washington
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OBJECTIVE

The authors sought to evaluate the contemporary management of pediatric open skull fractures and assess the impact of variations in antibiotic and operative management on the incidence of infectious complications.

METHODS

The records of children who presented from 2009 to 2017 to 6 pediatric trauma centers with an open calvarial skull fracture were reviewed. Data collected included mechanism and anatomical site of injury; presence and depth of fracture depression; antibiotic choice, route, and duration; operative management; and infectious complications.

RESULTS

Of the fractures among the 138 patients included in the study, 48.6% were frontal and 80.4% were depressed; 58.7% of patients underwent fragment elevation. The average duration of intravenous antibiotics was 4.6 (range 0–21) days. Only 53 patients (38.4%) received a single intravenous antibiotic for fewer than 4 days. and 56 (40.6%) received oral antibiotics for an average of 7.3 (range 1–20) days. Wounds were managed exclusively in the emergency department in 28.3% of patients. Two children had infectious complications, including a late-presenting hardware infection and a superficial wound infection. There were no cases of meningitis or intracranial abscess. Neither antibiotic spectrum or duration nor bedside irrigation was associated with the development of infection.

CONCLUSIONS

The incidence of infectious complications in this population of children with open skull fractures was low and was not associated with the antibiotic strategy or site of wound care. Most minimally contaminated open skull fractures are probably best managed with a short duration of a single antibiotic, and emergency department closure is appropriate unless there is significant contamination or fragment elevation is necessary.

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Contributor Notes

Correspondence Gerald Gollin: Rady Children’s Hospital, San Diego, CA. ggollin@rchsd.org.

INCLUDE WHEN CITING Published online March 12, 2021; DOI: 10.3171/2020.10.PEDS20486.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Ciurea AV, Gorgan MR, Tascu A, . Traumatic brain injury in infants and toddlers, 0-3 years old. J Med Life. 2011;4(3):234243.

  • 2

    Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23(6):377380.

    • Search Google Scholar
    • Export Citation
  • 3

    Mendelow AD, Campbell D, Tsementzis SA, . Prophylactic antimicrobial management of compound depressed skull fracture. J R Coll Surg Edinb. 1983;28(2):8083.

    • Search Google Scholar
    • Export Citation
  • 4

    Jennett B, Miller JD. Infection after depressed fracture of skull. Implications for management of nonmissile injuries. J Neurosurg. 1972;36(3):333339.

    • Search Google Scholar
    • Export Citation
  • 5

    Isaac SM, Woods A, Danial IN, Mourkus H. Antibiotic prophylaxis in adults with open tibial fractures: What is the evidence for duration of administration? A systematic review. J Foot Ankle Surg. 2016;55(1):146150.

    • Search Google Scholar
    • Export Citation
  • 6

    Meara DJ, Jones LC. Controversies in maxillofacial trauma. Oral Maxillofac Surg Clin North Am. 2017;29(4):391399.

  • 7

    Zosa BM, Elliott CW, Kurlander DE, . Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less. J Trauma Acute Care Surg. 2018;85(3):444450.

    • Search Google Scholar
    • Export Citation
  • 8

    Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.

    • Search Google Scholar
    • Export Citation
  • 9

    Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84(3):196200.

    • Search Google Scholar
    • Export Citation
  • 10

    Lee SL, Islam S, Cassidy LD, . Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2010;45(11):21812185.

    • Search Google Scholar
    • Export Citation
  • 11

    Srinivasan A. Antibiotic stewardship: why we must, how we can. Cleve Clin J Med. 2017;84(9):673679.

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