What is the relevance of a concurrent skull fracture in severe traumatic brain injury? According to a study in J Trauma dec 2011, the prescence of a skull fracture increases mortality in severe TBI by about 30%. Who would have thought? It is not the most exciting 15 minutes I had reading medical research, but I gave me a rough idea of what impact a skull fracture has in TBI.
Retrospective study of a total of 197 patients who had isolated severe TBI (GCS<9 at ED triage). The site was an university hospital. Paeds, multitrauma, traumatic cardiac arrest and no available CT images were exclusion criteria. Out of the 197 patients 46,7% had a skull fracture in the ED. 92 patients had a fractured skull while 105 patients comprised the non fractured group. These groups were compared for hospital mortality.
Mortality in the skull fracture group was 64,1%.
Mortality in the non skull fracture group was 31,4%
Skull bone fracture might double mortality in severe TBI. Not surprising. Skull fractures imply the head was hit with energy high enough to break skull bones. Consequently, one would expect more severe tissue injury.
Study and abstract lives here.