Pediatric isolated linear skull fractures commonly result from head trauma and rarely require surgery, yet patients are often admitted to the hospital—a costly care plan. In this study, the authors utilized a national database to investigate trends in admission for skull fractures across the United States.

Children younger than 18 years with isolated linear skull fracture, according to ICD-9 diagnosis codes in the Kids’ Inpatient Database of the Healthcare and Utilization Project (HCUP), who presented between 2003 and 2016 were included. HCUP collected data in 2003, 2006, 2009, 2012, and 2016. Children with a depressed skull fracture, multiple traumatic injuries, and acute intracranial findings were excluded. Sample-level data were translated into population-level data by using an HCUP-specific discharge weight.

Overall, 11,355 patients (64% males) were admitted to 1605 hospitals. National admissions decreased from 3053 patients in 2003 to 1203 in 2016. The mean ± SD age at admission also decreased from 6.3 ± 5.9 years to 1.2 ± 3.0 years (p < 0.001). The proportion of patients in the lowest quartile of median household income increased by 9%, while that in the highest income quartile decreased by 7% (p < 0.001). Admission was generally more common in the summer months (June, July, and August) and on weekdays (68%). The mean ± SD hospital length of stay decreased from 2.0 ± 3.1 days to 1.4 ± 1.4 days between 2003 and 2012, and then increased to 2.1 ± 6.8 days in 2016 (p < 0.001). When adjusted for inflation, the mean total hospital charges increased from $13,099 to $21,204 (p < 0.001). The greatest proportion of admissions was in the South (35%), and the lowest was in the Northeast (17%). The proportion of patients admitted to large hospitals increased (59% to 72%, p < 0.001), which corresponded to a decrease in patients admitted to small hospitals (16% to 9%, p < 0.001). Overall, the total proportion of admissions to rural hospitals decreased by 6%, and that to urban teaching centers increased by 15% (p < 0.001). Since 2003, no child has undergone a neurosurgical procedure or died as an inpatient.

This study identified a general nationwide decrease in admissions for pediatric linear isolated skull fracture, but associated costs increased. Admissions became less common at smaller rural hospitals and more common at larger urban teaching hospitals. This patient population required no inpatient neurosurgical intervention after 2003.

小儿孤立性线性颅骨骨折通常由头部外伤引起，很少需要手术，但患者经常住院——这是一项昂贵的护理计划。在这项研究中，作者利用一个国家数据库来调查美国颅骨骨折入院的趋势。

根据医疗保健和利用项目 (HCUP) 儿童住院患者数据库中的 ICD-9 诊断代码，18 岁以下患有孤立性线性颅骨骨折的儿童包括在 2003 年至 2016 年之间。HCUP 收集了 2003 年、2006 年、2009 年、2012 年和 2016 年的数据。排除了颅骨凹陷骨折、多发性创伤和急性颅内发现的儿童。通过使用特定于 HCUP 的排放权重，将样本级数据转换为人口级数据。

总体而言，1605 家医院收治了 11,355 名患者（64% 为男性）。全国入院人数从 2003 年的 3053 人减少到 2016 年的 1203 人。入院时的平均 ± SD 年龄也从 6.3 ± 5.9 岁降至 1.2 ± 3.0 岁（p < 0.001）。家庭收入中位数最低四分位数的患者比例增加了 9%，而收入最高四分位数的患者比例下降了 7%（p < 0.001）。夏季（6 月、7 月和 8 月）和工作日（68%）的入学率普遍更高。2003 年至 2012 年间，平均 ± SD 住院天数从 2.0 ± 3.1 天减少到 1.4 ± 1.4 天，然后在 2016 年增加到 2.1 ± 6.8 天（p < 0.001）。根据通货膨胀调整后，平均住院总费用从 13,099 美元增加到 21,204 美元（p < 0.001）。录取比例最高的是南方（35%），最低的是东北部（17%）。大医院收治的患者比例增加（59% 至 72%，p < 0.001），而小医院收治的患者比例下降（16% 至 9%，p < 0.001）。总体来看，农村医院住院总比例下降6%，城市教学中心住院比例上升15%（p < 0.001）。自 2003 年以来，没有儿童接受过神经外科手术或因住院而死亡。而到城市教学中心的增长15%（p < 0.001）。自 2003 年以来，没有儿童接受过神经外科手术或因住院而死亡。而到城市教学中心的增长15%（p < 0.001）。自 2003 年以来，没有儿童接受过神经外科手术或因住院而死亡。

该研究发现，全国范围内儿童线性孤立性颅骨骨折的入院率普遍下降，但相关费用增加。在较小的农村医院，住院变得不那么常见，而在较大的城市教学医院则更为常见。该患者群体在 2003 年之后不需要住院神经外科干预。