Outcomes of Isolated Basilar Skull Fracture: Readmission, Meningitis, and Cerebrospinal Fluid Leak. Issue 6 (17th October 2013) - McCutcheon, Brandon A.
Abstract : Objective: To determine rates of cerebrospinal fluid (CSF) leak, meningitis, and readmission in pediatric and adult patients with isolated basilar skull fracture. Study Design: Cross‐sectional analysis of a statewide database. Subjects: Patients with isolated basilar skull fracture (1995‐2010). Methods: Patients were identified within the California Office of Statewide Health Planning and Development database using ICD‐9 diagnosis codes. Results: A total of 3563 pediatric and 10, 761 adult patients met inclusion criteria. In‐hospital rates of meningitis (0.48% and 0.64%, P =. 3360) and CSF leak (2.33% and 1.75%, P =. 0270) were similar among children and adults, respectively. Rates of 90‐day meningitis (0.17% and 0.37%, P =. 0714) and CSF leak (0.40% and 0.40%, P =. 9823) were also similar. Thirty‐day readmission was 4.6% for children compared with 12.4% for adults ( P <. 001). For both pediatric and adult patients, extra‐axial hematoma (odds ratio [OR] [confidence interval {CI}] 1.65 [1.05‐2.59] and 1.61 [1.34‐1.95]) and comorbidities (OR [CI] 2.19 [1.11‐4.34] and 1.28 [1.04‐1.59]) were associated with significant increases in 30‐day readmission. Loss of consciousness greater than 1 hour (OR, 3.05; 95% CI, 1.53‐6.08) and CSF leak (OR, 3.28; 95% CI, 1.41‐7.64) increased the likelihood of pediatric readmissions. Lack of insurance (OR, 0.67; 95% CI, 0.50‐0.90) and female gender (OR 0.83; 95% CI, 0.70‐0.99) reduced the likelihood of adult readmission. Conclusion: Meningitis and CSF leak following isolated basilar skull fractures are uncommon. Readmission within 30 days was more common in adults than in children. CSF leak, hematoma, and prolonged loss of consciousness increased the likelihood of readmission in children. Intracranial injury, male gender, having insurance, and comorbidities increased the likelihood of readmission in adults.