Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma

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• 作者：Michael G. Tunik ; MD^a ; ^{mt12@nyu.edu" class="auth_mail" title="E-mail the corresponding author} ; Elizabeth C. Powell ; MD ; MPH^b ; Prashant Mahajan ; MD ; MPH^c ; Jeff E. Schunk ; MD^d ; Elizabeth Jacobs ; MD^f ; Michelle Miskin ; MS^d ; ^e ; Sally Jo Zuspan ; RN ; MSN^d ; ^e ; Sandra Wootton-Gorges ; MD^g ; Shireen M. Atabaki ; MD ; MPH^h ; John D. Hoyle Jr. ; MDⁱ ; ^j ; James F. Holmes Jr. ; MD ; MPH^k ; Peter S. Dayan ; MD ; MSc^m ; Nathan Kuppermann ; MD ; MPH^k ; ^l ; for the Pediatric Emergency Care Applied Research Network (PECARN)^&dagger ; ; M. Gerardi ; M. Tunik ; J. Tsung ; K. Melville ; L. Lee ; P. Mahajan ; P. Dayan ; F. Nadel ; E. Powell ; S. Atabaki ; K. Brown ; T. Glass ; J. Hoyle ; A. Cooper ; E. Jacobs ; D. Monroe ; D. Borgialli ; M. Gorelick ; S. Bandyopadhyay ; M. Bachman ; N. Schamban ; J. Callahan ; N. Kuppermann ; J. Holmes ; R. Lichenstein ; R. Stanley ; M. Badawy ; L. Babcock-Cimpello ; J. Schunk ; K. Quayle ; D. Jaffe ; K. Lillis ; PECARN Steering Committee
• 刊名：Annals of Emergency Medicine
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：68
• 期：4
• 页码：431-440.e1
• 全文大小：275 K

文摘

We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma.

Methods

This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT).

Results

Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT.

Conclusion

Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.