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No "policy" in our shop, just old fashioned clinical judgement, based on considerations mentioned before , the literature that supports discharge when certain conditions are met ,   and the length of time since the trauma ( we see them occasionally a day later...)

Giora

On Jan 17, 2015, at 2:13 PM, "Jay Fisher" <[log in to unmask]> wrote:

> 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:
>>                 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
>> 
>> 
>> 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



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