Prevalence and predictors of dural tear in depressed skull fractures: Insights from a systematic review and preliminary model from resource-limited settings

Introduction Traumatic brain injury (TBI) remains a major cause of morbidity and mortality globally, with depressed skull fractures (DSFs) being a significant subtype often accompanied by complications such as dural tears, which increase the risk of infection, cerebrospinal fluid leaks, and neurological deficits. While various studies have explored dural tears within the broader context of TBI, there is limited focus on the specific risk factors associated with DSFs, making the need for a focused predictive framework essential. Methods A comprehensive literature search was conducted in PubMed, EMBASE, Science Direct, and Web of Science databases, including studies that focused on DSF patients with documented dural tear predictors. Eight studies involving 672 patients met inclusion criteria. Key predictors of dural tear were identified, and points were assigned based on the strength of association. Results The pooled prevalence of dural tears in DSF patients was 51% (95% CI: 34%–67%), with high heterogeneity ( I 2 = 97.6%), which appears higher than figures reported in studies from high-resource settings. This discrepancy may reflect differences in trauma mechanisms, such as assault-related injuries. Key predictors with strong associations included compound fracture nature, depression depth >14 mm, pneumocephalus, brain contusion or intracerebral hemorrhage, epidural hematoma, and assaultive nature of the trauma. The scoring framework assigned 2 points for high-strength predictors and 1 point for moderate-strength predictors, with total scores indicating low (0–4), moderate (5–7), and high (8–11) risk categories for dural tear. While this study did not conduct a pooled meta-analysis for individual predictors, the scoring framework relied on the most consistently reported and statistically significant predictors across multiple studies. Conclusion This study highlights the substantial burden of dural tears among DSF patients in resource-limited settings and proposes a preliminary scoring framework for early risk assessment. The model remains exploratory and requires validation through prospective studies. Further research comparing outcomes and management strategies in diverse healthcare environments is warranted to determine the global generalizability of these findings.