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Pediatric Basilar Skull Fracture Mechanisms and Trends From 2007 to 2018
Anthony Magit1,2, Joshua A Stramiello1, Raquel Good2
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA.
Insights
Pediatric basilar skull fractures are most commonly caused by falls and unhelmeted rider incidents. Helmet use significantly reduces injury risk, and policy changes have decreased motor vehicle accident-related fractures.
Area of Science:
- Pediatric Traumatology
- Injury Epidemiology
- Public Health
Background:
- Pediatric basilar skull fractures represent a significant public health concern.
- Understanding injury mechanisms is crucial for developing effective prevention strategies.
Purpose of the Study:
- To identify the primary mechanisms and trends of pediatric basilar skull fractures.
- To analyze demographic patterns associated with different injury types.
Main Methods:
- Retrospective review of a trauma database from a tertiary care children's hospital (2007-2018).
- Identification of pediatric patients (≤18 years) with basilar skull fractures using ICD-9 and ICD-10 codes.
- Analysis of injury mechanisms, patient demographics, and injury trends over time.
Main Results:
- Multilevel falls (mean age 4 years) and unhelmeted rider falls (mean age 11.2 years) were the most frequent causes.
- A notable increase in toddler injuries from television/entertainment center falls occurred between 2007-2011.
- Helmeted rider and motor vehicle accident injuries were less common.
Conclusions:
- Falls and unhelmeted riding are leading causes of pediatric basilar skull fractures.
- Helmet use is a critical protective factor, as evidenced by the rarity of helmeted rider injuries.
- Policy and behavioral changes have successfully reduced motor vehicle accident-related injuries.
Objectives:
To evaluate the specific mechanism and trend of injury resulting in pediatric basilar skull fractures.
Study Design:
Retrospective chart review of a trauma database.
Setting:
Tertiary care children's hospital.
Methods:
Patients ≤18 years old with basilar skull fractures were identified via the trauma database for admissions from 2007 to 2018. Patients were identified with ICD-9 codes (801.0, 801.1, 801.2, 801.3 or 801.4) and ICD-10 codes (S02.1, S02.10, S02.11, S02.19) for skull base fractures (International Classification of Diseases, Ninth Revision and Tenth Revision).
Results:
A total of 729 patients were included: 251 females and 478 males. The 2 most common mechanisms of injury are multilevel falls and unhelmeted rider falls. Multilevel falls occur more in the toddler age group (average age, 4 years), and unhelmeted rider falls are seen in the older age group (average age, 11.2 years). Helmeted rider and motor vehicle accident basilar skull injuries are relatively uncommon. There was a spike in television/entertainment center mechanisms of injury in toddlers from 2007 to 2011 but has since decreased.
Conclusion:
Pediatric basilar skull fractures are costly to the health care system, as patients spent more time in intensive care unit beds with a charge limited to hospital rooms between $1.7 and $2.7 million per year. The protective effect of helmets is demonstrated by unhelmeted rider injuries being the second-most common mechanism of basilar skull fractures and by helmeted rider injuries being rare. The small proportion of basilar skull fractures from motor vehicle accidents is an example of policy and behavioral changes resulting in decreased injury.
