Risk Factors for Admission and Prolonged Length of Stay in Pediatric Isolated Skull Fractures
| Autor: | William T. Basco, Anbesaw W. Selassie, William S. Russell, Daniel C. Williams, Keith T. Borg |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty South Carolina Logistic regression Odds Cohort Studies Risk Factors Medicine Humans Registries Retrospective Studies Skull Fractures business.industry Infant Retrospective cohort study General Medicine Emergency department Odds ratio Length of Stay Confidence interval Patient Discharge Hospitalization Logistic Models Concomitant Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Emergency Medicine Female business Cohort study |
| Zdroj: | Pediatric emergency care. 33(12) |
| ISSN: | 1535-1815 |
| Popis: | Objectives This study aimed to assess management of pediatric isolated skull fracture (ISF) patients by determining frequency of admission and describing characteristics associated with patients admitted for observation compared with patients discharged directly from the emergency department (ED) and those requiring a prolonged hospitalization. Methods We evaluated children younger than 5 years who presented with ISF using the South Carolina Traumatic Brain Injury Surveillance and Registry System data from 2001 to 2011. Outcomes analyzed included discharged from ED, admitted for less than 24 hours, and admitted for more than 24 hours (prolonged hospitalization). Bivariate analyses and a polytomous logistic regression model identified factors associated with patient disposition. Results Five hundred twenty-seven patients met the study criteria (ED discharge = 283 [53%]; inpatient 24 hours = 88 [18%]). The mean length of stay for admissions was 1.9 (SD, 1.5) days. In the regression model, ED discharges had greater odds of presenting to levels 2 to 3 hospitals (level 2: odds ratio [OR], 6.16; 95% confidence interval [CI], 3.66-10.39; level 3: OR, 30.98; 95% CI, 10.92-87.91) and lower odds of a high poverty status (OR, 0.20; 95% CI, 0.10-0.40). Prolonged hospitalizations had greater odds of concomitant injuries (OR, 2.21; 95% CI, 1.12-4.36). Conclusions Admission after ISF is high despite a low risk of deterioration. High-poverty patients presenting to high-acuity medical centers are more commonly admitted for observation. Only presence of concomitant injuries was clinically predictive of prolonged hospitalization. The ability to better stratify risk after pediatric ISF would help providers make more informed decisions regarding ED disposition. |
| Databáze: | OpenAIRE |
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