The Utility of Extensive Lab Workup in Pediatric Patients with Minor Skull Fractures: A Retrospective Cohort Study

Introduction: Children with minor skull fractures are at low risk of complications, and few require neurosurgical intervention. However, such children are often admitted to the hospital, and extensive lab workup is performed, which may cause additional pain and cost to patients. The objective of this study was to analyze the utility of labs in the workup of minor pediatric skull fractures.

Methods: A retrospective chart review investigated pediatric ( < 18 y/o) patients who presented to our institution with minor skull fractures from 2015-2022. Exclusion criteria included skull-base fractures; facial fractures; intracerebral, subarachnoid, or epidural hemorrhage; initial GCS < 14; and other injuries necessitating inpatient hospitalization. Data collected included demographics, mechanisms of injury (MOI), neuroimaging findings, clinical status, and lab values. Primary outcomes of interest were whether labs were ordered and length of admission. Hemoglobin & hematocrit for cephalohematoma monitoring were not counted toward labs ordered. Fisher’s Exact and Mann-Whitney U tests were used to determine associations between labs ordered and clinical status.

Results: Of 135 pediatric patients included in this study, the majority were male (59%) and white (72%). Average age was 2.2 years. Most patients had labs ordered (n=114, 84%). Decision to order labs was not significantly associated with MOI, time of presentation, GCS, PECARN score, or insurance status. Patients were more likely to have labs ordered if they presented on weekends compared to weekdays (p=0.056). The decision to order labs was not significantly associated with length of hospital stay (p=0.151). The majority of patients had at least one abnormal lab, but abnormal labs rarely influenced patient care or clinical decision-making.

Conclusion : This study provides insight for the hypothesis that extensive laboratory workup may not significantly influence clinical decision-making for patients with minor skull fractures. In these patients, ordering labs might incur costs and cause discomfort without a significant impact on care.