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Objective: A recent Internet survey of pediatric neurosurgeons showed that 86% routinely admitted children with immediate posttraumatic seizures (PTS) for a brief period of observation. We wished to determine whether certain children meeting predefined criteria could instead be safely discharged from the emergency room. Methods: We reviewed the records of children admitted during the past 5 years with a diagnosis of seizure and head injury. Children with a minor head injury, a PTS occurring within 24 h of injury and no intracranial abnormalities on admission CT scan were included. Children with previous neurological conditions, a history of prior seizures (other than PTS or febrile seizures), a prior history of anticonvulsant use, or intracranial abnormalities on the admission CT scan were excluded. Records were abstracted for child’s age, gender, length of admission, previous history of PTS or febrile seizures, mechanism of injury, location of impact, time between impact and PTS, the number, length and type of PTS, Glasgow Coma Score (GCS) on admission, subsequent complications and hospital costs. Results: Seventy-one children met the inclusion criteria. Eleven children presented to the emergency room with prolonged seizures, transient apnea or persistently low GCS and required admission to the intensive care unit (ICU). Among the 60 remaining children with simple PTS, none had further seizures during the follow-up period, and none had significant complications. The average cost of hospitalization was known for 58 children; after excluding the costs for 5 patients who were admitted to the ICU, the average hospital cost amounted to USD 1,615 per patient. Conclusions: Our data suggest that children with isolated minor head injuries and simple PTS who recover fully in the emergency room, whose CT scans show no intracranial abnormalities and who have no prior history of neurological disease, epilepsy or anticonvulsant use are at low risk for recurrent seizures or neurological complications, and could potentially be sent home to a reliable caretaker and a stable home situation. However, because of the limited sample size in this study, the statistical risk of a bad outcome may be as high as 9%; we therefore suggest that much larger studies are potentially needed before this becomes a standard policy.

The American Society of Pediatric Neurosurgeons (ASPN) has expressed a commitment to have all of its members’ qualifying research efforts published in peer-reviewed pediatric neurosurgical journals such as Pediatric Neurosurgery. To test this commitment, citations from January 1985 through December 1994 were analyzed for all 76 current members of the ASPN. The citations were divided into those of general or adult neurosurgical interest, and those of pediatric neurosurgical interest based upon title, key words, and/or abstract. Each pediatric neurosurgical citation was further classified by topic, and by the type of journal in which it appeared (pediatric neurosurgical, general or adult neurosurgical, and other pediatric or adult journal, subspecialty journal, or basic science journal). A total of 1,887 individual author citations were identified during the study period; of these, 1,586 citations (84%) were classified as pediatric neurosurgical citations. These included 1,391 citations from peer-reviewed publications and 195 citations from Concepts in Pediatric Neurosurgery. As a society, the ASPN published only one third of its citations in peer-reviewed pediatric neurosurgery journals; the remainder were cited in general neurosurgical or other journals. Even when only citations from neurosurgical journals (in which pediatric neurosurgeons were more likely to be primary authors and therefore to have more control over the journal of publication) were analyzed, less than 50% of citations appeared in peer-reviewed pediatric neurosurgery journals. Nearly three quarters of ASPN members failed to provide even a modest commitment – publishing 51% or more of their pediatric citations in peer-reviewed pediatric neurosurgical journals. When the analysis was again limited to only those citations published in neurosurgery journals, over half of the members failed this ‘51% rule’. These results suggest the need for a firmer commitment from ASPN members to publish in peer-reviewed pediatric neurosurgery journals.

Occipital plagiocephaly is characterized by both unilateral occipital flattening and ipsilateral frontal prominence with anterior deviation of the ipsilateral ear, yielding a characteristic parallelogram shape to the cranium. Radiographic changes in the lambdoid suture are often evident, but the lambdoid suture is usually patent over most or all of its length on skull X-rays and/or CT scans. Both lambdoid synostosis and deformational forces have been implicated as potentially causal in the pathogenesis of this deformity. We proposed a unifying theory which incorporates a common pathogenesis for both deformational plagiocephaly and most cases of lambdoid 'synostosis'. According to this hypothesis, intrauterine and/or postnatal deformation forces are responsible for the primary calvarial deformation. These forces initially act in reversible manner to produce the typical parallelogram-shaped skull deformity. However, with continued deformation, more enduring secondary pathological changes may eventually occur in the lambdoid suture and basicranium which are more difficult to correct even if the offending deformational forces are subsequently removed or reversed.