The association between skull bone fractures and outcomes in patients with severe traumatic brain injury

J Trauma. 2011 Dec;71(6):1611-4; discussion 1614. doi: 10.1097/TA.0b013e31823a8a60.


Background: In traumatic brain injury (TBI), computed tomography (CT) provides a good assessment of anatomic pathologic findings and the prognostic value of CT characteristics has been well discussed. However, few studies have focused on skull bone fracture and its clinical prognostic importance. Hence, this study aims to evaluate the effects of skull bone fracture on patients with severe TBI admitted to the emergency unit.

Methods: We reviewed the medical records of patients with isolated severe TBI admitted to the emergency unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on the presence of skull bone fracture identified by the CT scan while in the emergency unit. Mann-Whitney U test and a Student's t test were used to identify the differences between the two groups, whereas logistic regression was applied to determine any significant differences found in the statistical analysis.

Results: A total of 197 patients were signed up in our study. Based on the presence of skull bone fracture on CT scan at emergency department, 92 patients (46.7%) comprised the skull bone fracture group and 59 patients (64.1%) of these died. One hundred five patients (53.3%) comprised the nonskull bone fracture group, of which 33 patients (31.4%) died. There is significant difference between the two groups (p = 0.004).

Conclusion: This study shows that skull bone fracture is a mortality risk factor for patients with isolated severe blunt TBI.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Brain Injuries / diagnostic imaging*
  • Brain Injuries / epidemiology*
  • Brain Injuries / surgery
  • Cohort Studies
  • Comorbidity
  • Confidence Intervals
  • Female
  • Glasgow Coma Scale
  • Head Injuries, Closed / diagnostic imaging*
  • Head Injuries, Closed / epidemiology
  • Head Injuries, Closed / surgery
  • Hematoma, Subdural / diagnostic imaging
  • Hematoma, Subdural / epidemiology
  • Hematoma, Subdural / surgery
  • Humans
  • Incidence
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Skull Fractures / diagnostic imaging*
  • Skull Fractures / epidemiology*
  • Skull Fractures / therapy
  • Statistics, Nonparametric
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / epidemiology
  • Subarachnoid Hemorrhage / therapy
  • Survival Analysis
  • Taiwan / epidemiology
  • Tomography, X-Ray Computed / methods*