Contribution of Skull Fractures to Traumatic Brain Injury: A Descriptive Analysis of Skull Fracture Classification Within the modified Brain Injury Guidelines
Retrospective study shows skull fractures increase intracranial injury severity and radiographic progression in blunt traumatic brain injury, highlighting their utility in risk triage.
Key Points
To compare intracranial injury severity, radiographic progression, and clinical outcomes between blunt traumatic brain injury patients with and without skull fractures.
Analyzed a retrospective cohort of 2,543 prospectively triaged adult trauma patients with blunt traumatic brain injury and radiographic evidence of intracranial hemorrhage or skull fracture.
Categorized patients by the presence, absence, and displacement of skull fractures, utilizing multivariable logistic regression to determine independent predictors of radiographic progression and mortality.
Skull fractures were identified in 24.6% (n = 626) of patients and were associated with higher rates of midline shift, all intracranial hemorrhage subtypes (subarachnoid hemorrhage being most frequent), and neurosurgical intervention.
Multivariable analysis identified skull fractures as an independent predictor of radiographic progression on head computed tomography, though not of overall mortality.
Patients with skull fractures experienced longer median hospital and intensive care unit lengths of stay and higher overall mortality, with displaced fractures exhibiting worse outcomes than nondisplaced fractures.