Outcomes of Isolated Basilar Skull Fracture

Author:

McCutcheon Brandon A.1,Orosco Ryan K.1,Chang David C.2,Salazar Francesca R.2,Talamini Mark A.2,Maturo Stephen3,Magit Anthony1

Affiliation:

1. Division of Head and Neck Surgery, University of California San Diego, San Diego, California, USA

2. Department of Surgery, University of California San Diego, San Diego, California, USA

3. Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA

Abstract

Objective To determine rates of cerebrospinal fluid (CSF) leak, meningitis, and readmission in pediatric and adult patients with isolated basilar skull fracture. Study Design Cross-sectional analysis of a statewide database. Subjects Patients with isolated basilar skull fracture (1995-2010). Methods Patients were identified within the California Office of Statewide Health Planning and Development database using ICD-9 diagnosis codes. Results A total of 3563 pediatric and 10,761 adult patients met inclusion criteria. In-hospital rates of meningitis (0.48% and 0.64%, P = .3360) and CSF leak (2.33% and 1.75%, P = .0270) were similar among children and adults, respectively. Rates of 90-day meningitis (0.17% and 0.37%, P = .0714) and CSF leak (0.40% and 0.40%, P = .9823) were also similar. Thirty-day readmission was 4.6% for children compared with 12.4% for adults ( P < .001). For both pediatric and adult patients, extra-axial hematoma (odds ratio [OR] [confidence interval {CI}] 1.65 [1.05-2.59] and 1.61 [1.34-1.95]) and comorbidities (OR [CI] 2.19 [1.11-4.34] and 1.28 [1.04-1.59]) were associated with significant increases in 30-day readmission. Loss of consciousness greater than 1 hour (OR, 3.05; 95% CI, 1.53-6.08) and CSF leak (OR, 3.28; 95% CI, 1.41-7.64) increased the likelihood of pediatric readmissions. Lack of insurance (OR, 0.67; 95% CI, 0.50-0.90) and female gender (OR 0.83; 95% CI, 0.70-0.99) reduced the likelihood of adult readmission. Conclusion Meningitis and CSF leak following isolated basilar skull fractures are uncommon. Readmission within 30 days was more common in adults than in children. CSF leak, hematoma, and prolonged loss of consciousness increased the likelihood of readmission in children. Intracranial injury, male gender, having insurance, and comorbidities increased the likelihood of readmission in adults.

Publisher

SAGE Publications

Subject

Otorhinolaryngology,Surgery

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