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Advancing pediatric emergency care and saving millions

Treating children who arrive in the ER with isolated skull fractures is a complicated matter. When should they be hospitalized, when should they be discharged home? Are emergency physicians doing enough to improve care for these children when they present to the ED? With the advancement of pediatric emergency care in mind, two recent studies focused on this subset of pediatric patients.

The first study1 looked at the outcome of children presenting to the ED with isolated skull fractures between 2005 and 2011, and found that 85% were discharged within 24 hours and 95% were discharged within 2 days. Of the 1.2% of the children that were hospitalized, these children received CT imaging, with one child requiring a neurosurgical procedure.

“Although only 1% of children evaluated in the emergency department for head trauma will require neurosurgical intervention, head trauma results in over 50,000 hospitalizations and $1 billion in hospitalization costs every year,” said lead study author Rebekah Mannix, MD, MPH, of Boston Children’s Hospital in Boston, Mass. “Further investigation is needed to determine whether so many admissions are warranted and if patient safety and cost-effectiveness might both be satisfied by discharging more children with skull fractures home.”

The second study2 compared two new devices, the 2D- and 3D-Mercy TAPEs, against the more commonly used Broselow method to see which most accurately estimated a child’s weight, leading to more precise drug dosing in the ER.

“The Mercy TAPEs outperformed the Broselow tape for pediatric weight estimation and can be used in a wider range of children, without the height restrictions of the Broselow tape that limit its use in approximately one-third of the pediatric population” said lead study author Susan Abdel-Rahman, PharmD, of the Children’s Mercy Hospitals and Clinics in Kansas City, Mo. “It may prove useful for emergency care, with perhaps an even bigger impact on the care of children in limited-resource settings.”

The studies indicate that children with isolated skull fractures may not need to be hospitalized, a finding that has the potential to save the health care system millions each year.

References 1. Isolated skull fractures: Trends in management in U.S. pediatric emergency departments. Ann Emerg Med. 2013 [Epub ahead of print]. 2. Evaluation of the Mercy TAPE: Performance against the standard for pediatric weight estimation. Ann Emerg Med. 2013 [Epub ahead of print].