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We are at a Level 1 adult, level 2 Peds trauma center and we will send
selected patients with isolated skull fx home -

There are several recent studies on this demonstrating that this is a
reasonable practice-

Mannix 2013 - Ann EM- 861 managed as outpatients - 1 percent returned for
admit without bad outcome

Rollins 2013 - J Peds Surg - 235 kids, 25% managed as outpatients without
adverse outcome - 1 admitted kid developed a 'sliver EDH' which did not
require intervention.


Jay Fisher MD
Peds EM
Children's Hospital of NV

On Sat, Jan 17, 2015 at 6:02 AM, Todd Zimmerman <
[log in to unmask]> wrote:

> I direct 2 peds eds...both peds eds see about 18,000 and both ed totals
> see about 30000 kids give or take and we assess this on a case by case
> basis.
> Yes, meeting similiar mentioned circumstances we may send home.
> Lots of considerations here.
> TZ
>
>
> Sent from my Verizon Wireless 4G LTE smartphone
>
>
> -------- Original message --------
> From: "Mittal, Manoj K" <[log in to unmask]>
> Date:01/17/2015  1:49 AM  (GMT-06:00)
> To: [log in to unmask]
> Subject: Re: Isolated skull fractures
>
> Discharge home after assessment for abuse, intracranial and other injury.
> No mandated consults.
>
> Rick,
> What is the rationale provided by your specialists for admission?
>
> Thanks,
> Manoj
> Manoj Mittal, MD
> CHOP
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List [
> [log in to unmask]] on behalf of Vezzetti [
> [log in to unmask]]
> Sent: Friday, January 16, 2015 6:29 PM
> To: [log in to unmask]
> Subject: Re: Isolated skull fractures
>
> Hi Rick,
>
> We have a policy that allows patients with isolated linear skull fractures
> to be discharged as well.  This occurs when other injuries gave been ruled
> out, social work has seen the patient, and after speaking to neurosurgery.
> If there's any doubt or other injury, the child is admitted.
>
> Bob
>
> R Vezzetti, MD, FAAP, FACEP
> Pediatric Emergency Medicine
> Dell Children's Medical Center
>
> > On Jan 16, 2015, at 3:17 PM, Rick Place <[log in to unmask]> wrote:
> >
> > The specialists at our institutions believe that all isolated skull
> > fractures should be admitted for observation overnight.
> >
> > Are there large institutions who have a policy (formal or informal) which
> > permit discharge of an isolated skull fracture in a well appearing infant
> > (or older child) with a good story and no intracranial issues?
> >
> > Thanks
> >
> > Rick Place
> > Fairfax VA
> >
> > For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >                 http://listserv.brown.edu/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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>
> For more information, send mail to [log in to unmask] with the
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> The URL for the PED-EM-L Web Page is:
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>
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html