Admission trends in pediatric isolated linear skull fracture across the United States

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  • 1 Vanderbilt University School of Medicine, Nashville;
  • | 2 Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville;
  • | 3 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • | 4 Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California; and
  • | 5 Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
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OBJECTIVE

Pediatric isolated linear skull fractures commonly result from head trauma and rarely require surgery, yet patients are often admitted to the hospital—a costly care plan. In this study, the authors utilized a national database to investigate trends in admission for skull fractures across the United States.

METHODS

Children younger than 18 years with isolated linear skull fracture, according to ICD-9 diagnosis codes in the Kids’ Inpatient Database of the Healthcare and Utilization Project (HCUP), who presented between 2003 and 2016 were included. HCUP collected data in 2003, 2006, 2009, 2012, and 2016. Children with a depressed skull fracture, multiple traumatic injuries, and acute intracranial findings were excluded. Sample-level data were translated into population-level data by using an HCUP-specific discharge weight.

RESULTS

Overall, 11,355 patients (64% males) were admitted to 1605 hospitals. National admissions decreased from 3053 patients in 2003 to 1203 in 2016. The mean ± SD age at admission also decreased from 6.3 ± 5.9 years to 1.2 ± 3.0 years (p < 0.001). The proportion of patients in the lowest quartile of median household income increased by 9%, while that in the highest income quartile decreased by 7% (p < 0.001). Admission was generally more common in the summer months (June, July, and August) and on weekdays (68%). The mean ± SD hospital length of stay decreased from 2.0 ± 3.1 days to 1.4 ± 1.4 days between 2003 and 2012, and then increased to 2.1 ± 6.8 days in 2016 (p < 0.001). When adjusted for inflation, the mean total hospital charges increased from $13,099 to $21,204 (p < 0.001). The greatest proportion of admissions was in the South (35%), and the lowest was in the Northeast (17%). The proportion of patients admitted to large hospitals increased (59% to 72%, p < 0.001), which corresponded to a decrease in patients admitted to small hospitals (16% to 9%, p < 0.001). Overall, the total proportion of admissions to rural hospitals decreased by 6%, and that to urban teaching centers increased by 15% (p < 0.001). Since 2003, no child has undergone a neurosurgical procedure or died as an inpatient.

CONCLUSIONS

This study identified a general nationwide decrease in admissions for pediatric linear isolated skull fracture, but associated costs increased. Admissions became less common at smaller rural hospitals and more common at larger urban teaching hospitals. This patient population required no inpatient neurosurgical intervention after 2003.

ABBREVIATIONS

ED = emergency department; HCUP = Healthcare and Utilization Project; KID = Kids’ Inpatient Database; LOS = length of stay.

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Contributor Notes

Correspondence Rebecca A. Reynolds: Vanderbilt University Medical Center, Nashville, TN. rebecca.a.kasl@vumc.org.

INCLUDE WHEN CITING Published online June 4, 2021; DOI: 10.3171/2020.12.PEDS20659.

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

A.R.T. and R.A.R. contributed equally to this work.

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