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Kelsey Hayward, Sabrina H. Han, Alexander Simko, Hector E. James, and Philipp R. Aldana

OBJECTIVE

The objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).

METHODS

A PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.

RESULTS

Clinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.

CONCLUSIONS

Managing pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

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Cory McFall, Alexandra D. Beier, Kelsey Hayward, Emily C. Alberto, Randall S. Burd, Bethany J. Farr, David P. Mooney, Kristin Gee, Jeffrey S. Upperman, Mauricio A. Escobar Jr., Nicole G. Coufal, Helen A. Harvey, and Gerald Gollin

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.