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Clinical Indications for Discharge Unilateral, linear, nondepressed skull fractures without underlying intracranial injury in patients who not have a distracting traumatic injury with a normal neurologic examination may be discharged from the pediatric ED If there is any apprehension regarding the potential for nonaccidental trauma, social work consultation, as well as neurosurgical or surgical consultation, should be obtained prior to discharge Suggested Readings and Key References Adelson PD, Wisniewski SR, Beca J, et al; Paediatric Traumatic Brain Injury Consortium Comparison of hypothermia and normothermia after severe traumatic brain injury in children (cool kids): a phase 3, randomized controlled trial Lancet Neurol 2013;12(6):546–553 Anderson V, Catroppa C, Morse S, et al Recovery of intellectual ability following traumatic brain injury in childhood: impact of injury severity and age at injury Pediatric Neurosurg 2000;32:282–290 Babl FE, Borland ML, Phillips N, et al Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study Lancet 2017;389(10087):2393–2402 Bracken MB Steroids for acute spinal cord injury Cochrane Database Syst Rev 2012;1:CD001046 Bressan S, Marchetto L, Lyons TW, et al A systematic review and metaanalysis of the management and outcomes of isolated skull fractures in children Ann Emerg Med 2018;71(6):714–724.e4 Bressan S, Romanato S, Mion T, et al Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department Acad Emerg Med 2012;19(7):801–807 Centers for Disease Control and Prevention Surveillance Report of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014 Atlanta, GA: US Department of Health and Human Services, CDC; 2019 Available at HTTPS://www.cdc.gov/traumaticbraininjury Accessed April 27, 2019 Davis GA, Anderson V, Babl FE, et al What is the difference in concussion management in children as compared with adults? A systematic review Br J Sports Med 2017;51:949–957
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