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Short-term outcomes of skull fracture: a population-based study of survival and neurologic complications
W C Wiederholt1, L J Melton, J F Annegers
1Department of Neurosciences, School of Medicine, University of California, San Diego.
Abstract:
All Olmsted County, Minnesota, residents who experienced brain injury from 1935 through 1979 were identified and their medical records reviewed for survival and neurologic outcome. Minimum inclusion criteria included loss of consciousness or post-traumatic amnesia or neurologic evidence of brain injury or skull fracture. Of 4,660 cases identified, skull fractures were observed in 28%. Over half of brain-injured patients who died did so within 24 hours of trauma; among 1-day survivors, subsequent survival was moderately impaired, especially in older individuals. Mortality was lowest in subjects without a skull fracture and increased with fracture severity. Associated neurologic injuries, complications, and deficits were generally more common in patients with skull fracture than those without and were much more frequent with more severe skull fractures. The types of neurologic deficits differed little between those with and without fractures, except that subjects with complicated skull fractures had higher proportions of special sensory deficits and multiple deficits.
Insights
Brain injury survival rates were impacted by skull fractures. More severe fractures correlated with higher mortality and increased neurologic deficits in Olmsted County residents.
Area of Science:
- Neurology
- Trauma Surgery
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity.
- Understanding long-term outcomes of TBI, particularly in relation to skull fractures, is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the relationship between skull fractures and the survival and neurologic outcomes of individuals with traumatic brain injury.
- To analyze the impact of skull fracture severity on mortality and neurological deficits.
Main Methods:
- Retrospective review of medical records for Olmsted County, Minnesota residents with brain injury between 1935 and 1979.
- Inclusion criteria: loss of consciousness, post-traumatic amnesia, neurologic evidence of brain injury, or skull fracture.
- Analysis of survival data and neurologic outcomes based on the presence and severity of skull fractures.
Main Results:
- Skull fractures were present in 28% of 4,660 identified brain injury cases.
- Mortality was highest within 24 hours of trauma; subsequent survival was reduced, particularly in older individuals.
- Mortality increased with skull fracture severity, and neurologic injuries/deficits were more common with fractures, especially severe ones.
Conclusions:
- Skull fractures are associated with increased mortality and poorer neurologic outcomes following traumatic brain injury.
- The severity of a skull fracture is a significant prognostic factor for both survival and the development of neurologic deficits.
- These findings underscore the importance of considering skull fracture status in the assessment and management of TBI patients.