Social Determinants of Health and Their Role in Basilar Skull Fracture Outcomes: A Level 1 Trauma Multicenter...

This multicenter retrospective study evaluated the impact of social determinants of health (SDoHs) on presentation, management, and outcomes of basilar skull fractures (BSFs) across three Level 1 trauma centers in Arizona (2017-2022). A total of 502 adult patients with International Classification of Diseases, 10th Revision (ICD-10) defined BSF were included. Demographic and clinical variables-including age, sex, race, insurance status, housing status, and psychiatric or substance use history-were analyzed as proxies for SDoH. Multivariable regression models adjusted for comorbidity burden and extent of bone involvement. Motor vehicle collisions (45.0%) and falls (29.9%) were the most common mechanisms of injury. Most patients required Intensive Care Unit (ICU) admission (71.5%) and mechanical ventilation (45.0%), while 24.7% underwent surgical intervention. Complications occurred in 73.5% of patients, and in-hospital mortality was 13.1%. SDoHs were associated with differences in injury patterns and hospital course. Older patients were more likely to sustain fall-related injuries and had longer hospital stays, while younger patients more frequently sustained motor-vehicle-related injuries. Female patients were less likely to sustain assault-related injuries and less likely to require ICU admission. Non-White patients presented with more severe neurological injury and experienced longer ICU stays. Patients with private insurance had less severe presentations and shorter hospital and ICU stays compared with those with government insurance. No SDoH variables were associated with mortality. SDoHs significantly influence injury patterns and health care utilization in BSF. These findings highlight opportunities for targeted prevention and resource allocation to address disparities in neurotrauma care.