Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma

Michael G. Tunik; Elizabeth C. Powell; Prashant Mahajan; Jeff E. Schunk; Michelle Miskin; Sally Jo Zuspan; Michelle Miskin; Sally Jo Zuspan; Elizabeth Jacobs; Sandra Wootton-Gorges; Shireen M. Atabaki; John D. Hoyle; John D. Hoyle; James F. Holmes; Nathan Kuppermann; Nathan Kuppermann; Peter S. Dayan; M. Gerardi; M. Tunik; J. Tsung; K. Melville; S. Atabaki; K. Brown; T. Glass; J. Hoyle; A. Cooper; E. Jacobs; D. Monroe; D. Borgialli; M. Gorelick; S. Bandyopadhyay; M. Bachman; N. Schamban; J. Callahan; N. Kuppermann; J. Holmes; R. Lichenstein; R. Stanley; M. Badawy; L. Babcock-Cimpello; J. Schunk; K. Quayle; D. Jaffe; K. Lillis; N. Kuppermann; E. Alpern; J. Chamberlain; J. M. Dean; M. Gerardi; J. Goepp; M. Gorelick; J. Hoyle; D. Jaffe; C. Johns; N. Levick; P. Mahajan; R. Maio; K. Melville; S. Miller; D. Monroe; R. Ruddy; R. Stanley; D. Treloar; M. Tunik; A. Walker; D. Kavanaugh; H. Park; M. Dean; R. Holubkov; S. Knight; A. Donaldson; J. Chamberlain; M. Brown; H. Corneli; J. Goepp; R. Holubkov; P. Mahajan; K. Melville; E. Stremski; M. Tunik; M. Gorelick; E. Alpern; J. M. Dean; G. Foltin; J. Joseph; S. Miller; F. Moler; R. Stanley; S. Teach; D. Jaffe; K. Brown; A. Cooper; J. M. Dean; C. Johns; R. Maio; N. C. Mann; D. Monroe; K. Shaw; D. Teitelbaum; D. Treloar; R. Stanley; D. Alexander; J. Brown; M. Gerardi; M. Gregor; R. Holubkov; K. Lillis; B. Nordberg; R. Ruddy; M. Shults; A. Walker; N. Levick; J. Brennan; J. Brown; J. M. Dean; J. Hoyle; R. Maio; R. Ruddy; W. Schalick; T. Singh; J. Wright

doi:10.1016/j.annemergmed.2016.04.058

Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma

Michael G. Tunik, Elizabeth C. Powell, Prashant Mahajan, Jeff E. Schunk, Michelle Miskin, Sally Jo Zuspan, Michelle Miskin, Sally Jo Zuspan, Elizabeth Jacobs, Sandra Wootton-Gorges, Shireen M. Atabaki, John D. Hoyle, John D. Hoyle, James F. Holmes, Nathan Kuppermann, Nathan Kuppermann, Peter S. Dayan, M. Gerardi, M. Tunik, J. TsungK. Melville, S. Atabaki, K. Brown, T. Glass, J. Hoyle, A. Cooper, E. Jacobs, D. Monroe, D. Borgialli, M. Gorelick, S. Bandyopadhyay, M. Bachman, N. Schamban, J. Callahan, N. Kuppermann, J. Holmes, R. Lichenstein, R. Stanley, M. Badawy, L. Babcock-Cimpello, J. Schunk, K. Quayle, D. Jaffe, K. Lillis, N. Kuppermann, E. Alpern, J. Chamberlain, J. M. Dean, M. Gerardi, J. Goepp, M. Gorelick, J. Hoyle, D. Jaffe, C. Johns, N. Levick, P. Mahajan, R. Maio, K. Melville, S. Miller, D. Monroe, R. Ruddy, R. Stanley, D. Treloar, M. Tunik, A. Walker, D. Kavanaugh, H. Park, M. Dean, R. Holubkov, S. Knight, A. Donaldson, J. Chamberlain, M. Brown, H. Corneli, J. Goepp, R. Holubkov, P. Mahajan, K. Melville, E. Stremski, M. Tunik, M. Gorelick, E. Alpern, J. M. Dean, G. Foltin, J. Joseph, S. Miller, F. Moler, R. Stanley, S. Teach, D. Jaffe, K. Brown, A. Cooper, J. M. Dean, C. Johns, R. Maio, N. C. Mann, D. Monroe, K. Shaw, D. Teitelbaum, D. Treloar, R. Stanley, D. Alexander, J. Brown, M. Gerardi, M. Gregor, R. Holubkov, K. Lillis, B. Nordberg, R. Ruddy, M. Shults, A. Walker, N. Levick, J. Brennan, J. Brown, J. M. Dean, J. Hoyle, R. Maio, R. Ruddy, W. Schalick, T. Singh, J. Wright

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Abstract

Study objective We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. Methods This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Results Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT. Conclusion Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.

Original language	English (US)
Pages (from-to)	431-440.e1
Journal	Annals of emergency medicine
Volume	68
Issue number	4
DOIs	https://doi.org/10.1016/j.annemergmed.2016.04.058
State	Published - Oct 1 2016

ASJC Scopus subject areas

Emergency Medicine

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10.1016/j.annemergmed.2016.04.058

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Tunik, M. G., Powell, E. C., Mahajan, P., Schunk, J. E., Miskin, M., Zuspan, S. J., Miskin, M., Zuspan, S. J., Jacobs, E., Wootton-Gorges, S., Atabaki, S. M., Hoyle, J. D., Hoyle, J. D., Holmes, J. F., Kuppermann, N., Kuppermann, N., Dayan, P. S., Gerardi, M., Tunik, M., ... Wright, J. (2016). Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma. Annals of emergency medicine, 68(4), 431-440.e1. https://doi.org/10.1016/j.annemergmed.2016.04.058

Tunik, MG, Powell, EC, Mahajan, P, Schunk, JE, Miskin, M, Zuspan, SJ, Miskin, M, Zuspan, SJ, Jacobs, E, Wootton-Gorges, S, Atabaki, SM, Hoyle, JD, Hoyle, JD, Holmes, JF, Kuppermann, N, Kuppermann, N, Dayan, PS, Gerardi, M, Tunik, M, Tsung, J, Melville, K, Atabaki, S, Brown, K, Glass, T, Hoyle, J, Cooper, A, Jacobs, E, Monroe, D, Borgialli, D, Gorelick, M, Bandyopadhyay, S, Bachman, M, Schamban, N, Callahan, J, Kuppermann, N, Holmes, J, Lichenstein, R, Stanley, R, Badawy, M, Babcock-Cimpello, L, Schunk, J, Quayle, K, Jaffe, D, Lillis, K, Kuppermann, N, Alpern, E, Chamberlain, J, Dean, JM, Gerardi, M, Goepp, J, Gorelick, M, Hoyle, J, Jaffe, D, Johns, C, Levick, N, Mahajan, P, Maio, R, Melville, K, Miller, S, Monroe, D, Ruddy, R, Stanley, R, Treloar, D, Tunik, M, Walker, A, Kavanaugh, D, Park, H, Dean, M, Holubkov, R, Knight, S, Donaldson, A, Chamberlain, J, Brown, M, Corneli, H, Goepp, J, Holubkov, R, Mahajan, P, Melville, K, Stremski, E, Tunik, M, Gorelick, M, Alpern, E, Dean, JM, Foltin, G, Joseph, J, Miller, S, Moler, F, Stanley, R, Teach, S, Jaffe, D, Brown, K, Cooper, A, Dean, JM, Johns, C, Maio, R, Mann, NC, Monroe, D, Shaw, K, Teitelbaum, D, Treloar, D, Stanley, R, Alexander, D, Brown, J, Gerardi, M, Gregor, M, Holubkov, R, Lillis, K, Nordberg, B, Ruddy, R, Shults, M, Walker, A, Levick, N, Brennan, J, Brown, J, Dean, JM, Hoyle, J, Maio, R, Ruddy, R, Schalick, W, Singh, T & Wright, J 2016, 'Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma', Annals of emergency medicine, vol. 68, no. 4, pp. 431-440.e1. https://doi.org/10.1016/j.annemergmed.2016.04.058

@article{701f3fb3fd844561badf553525caeeb7,

title = "Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma",

abstract = "Study objective We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. Methods This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Results Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT. Conclusion Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.",

author = "Tunik, {Michael G.} and Powell, {Elizabeth C.} and Prashant Mahajan and Schunk, {Jeff E.} and Michelle Miskin and Zuspan, {Sally Jo} and Michelle Miskin and Zuspan, {Sally Jo} and Elizabeth Jacobs and Sandra Wootton-Gorges and Atabaki, {Shireen M.} and Hoyle, {John D.} and Hoyle, {John D.} and Holmes, {James F.} and Nathan Kuppermann and Nathan Kuppermann and Dayan, {Peter S.} and M. Gerardi and M. Tunik and J. Tsung and K. Melville and S. Atabaki and K. Brown and T. Glass and J. Hoyle and A. Cooper and E. Jacobs and D. Monroe and D. Borgialli and M. Gorelick and S. Bandyopadhyay and M. Bachman and N. Schamban and J. Callahan and N. Kuppermann and J. Holmes and R. Lichenstein and R. Stanley and M. Badawy and L. Babcock-Cimpello and J. Schunk and K. Quayle and D. Jaffe and K. Lillis and N. Kuppermann and E. Alpern and J. Chamberlain and Dean, {J. M.} and M. Gerardi and J. Goepp and M. Gorelick and J. Hoyle and D. Jaffe and C. Johns and N. Levick and P. Mahajan and R. Maio and K. Melville and S. Miller and D. Monroe and R. Ruddy and R. Stanley and D. Treloar and M. Tunik and A. Walker and D. Kavanaugh and H. Park and M. Dean and R. Holubkov and S. Knight and A. Donaldson and J. Chamberlain and M. Brown and H. Corneli and J. Goepp and R. Holubkov and P. Mahajan and K. Melville and E. Stremski and M. Tunik and M. Gorelick and E. Alpern and Dean, {J. M.} and G. Foltin and J. Joseph and S. Miller and F. Moler and R. Stanley and S. Teach and D. Jaffe and K. Brown and A. Cooper and Dean, {J. M.} and C. Johns and R. Maio and Mann, {N. C.} and D. Monroe and K. Shaw and D. Teitelbaum and D. Treloar and R. Stanley and D. Alexander and J. Brown and M. Gerardi and M. Gregor and R. Holubkov and K. Lillis and B. Nordberg and R. Ruddy and M. Shults and A. Walker and N. Levick and J. Brennan and J. Brown and Dean, {J. M.} and J. Hoyle and R. Maio and R. Ruddy and W. Schalick and T. Singh and J. Wright",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Emergency Physicians",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/j.annemergmed.2016.04.058",

language = "English (US)",

volume = "68",

pages = "431--440.e1",

journal = "Annals of emergency medicine",

issn = "0196-0644",

publisher = "Mosby Inc.",

number = "4",

}

TY - JOUR

T1 - Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma

AU - Tunik, Michael G.

AU - Powell, Elizabeth C.

AU - Mahajan, Prashant

AU - Schunk, Jeff E.

AU - Miskin, Michelle

AU - Zuspan, Sally Jo

AU - Miskin, Michelle

AU - Zuspan, Sally Jo

AU - Jacobs, Elizabeth

AU - Wootton-Gorges, Sandra

AU - Atabaki, Shireen M.

AU - Hoyle, John D.

AU - Holmes, James F.

AU - Kuppermann, Nathan

AU - Dayan, Peter S.

AU - Gerardi, M.

AU - Tunik, M.

AU - Tsung, J.

AU - Melville, K.

AU - Atabaki, S.

AU - Brown, K.

AU - Glass, T.

AU - Hoyle, J.

AU - Cooper, A.

AU - Jacobs, E.

AU - Monroe, D.

AU - Borgialli, D.

AU - Gorelick, M.

AU - Bandyopadhyay, S.

AU - Bachman, M.

AU - Schamban, N.

AU - Callahan, J.

AU - Kuppermann, N.

AU - Holmes, J.

AU - Lichenstein, R.

AU - Stanley, R.

AU - Badawy, M.

AU - Babcock-Cimpello, L.

AU - Schunk, J.

AU - Quayle, K.

AU - Jaffe, D.

AU - Lillis, K.

AU - Kuppermann, N.

AU - Alpern, E.

AU - Chamberlain, J.

AU - Dean, J. M.

AU - Gerardi, M.

AU - Goepp, J.

AU - Gorelick, M.

AU - Hoyle, J.

AU - Jaffe, D.

AU - Johns, C.

AU - Levick, N.

AU - Mahajan, P.

AU - Maio, R.

AU - Melville, K.

AU - Miller, S.

AU - Monroe, D.

AU - Ruddy, R.

AU - Stanley, R.

AU - Treloar, D.

AU - Tunik, M.

AU - Walker, A.

AU - Kavanaugh, D.

AU - Park, H.

AU - Dean, M.

AU - Holubkov, R.

AU - Knight, S.

AU - Donaldson, A.

AU - Chamberlain, J.

AU - Brown, M.

AU - Corneli, H.

AU - Goepp, J.

AU - Holubkov, R.

AU - Mahajan, P.

AU - Melville, K.

AU - Stremski, E.

AU - Tunik, M.

AU - Gorelick, M.

AU - Alpern, E.

AU - Dean, J. M.

AU - Foltin, G.

AU - Joseph, J.

AU - Miller, S.

AU - Moler, F.

AU - Stanley, R.

AU - Teach, S.

AU - Jaffe, D.

AU - Brown, K.

AU - Cooper, A.

AU - Dean, J. M.

AU - Johns, C.

AU - Maio, R.

AU - Mann, N. C.

AU - Monroe, D.

AU - Shaw, K.

AU - Teitelbaum, D.

AU - Treloar, D.

AU - Stanley, R.

AU - Alexander, D.

AU - Brown, J.

AU - Gerardi, M.

AU - Gregor, M.

AU - Holubkov, R.

AU - Lillis, K.

AU - Nordberg, B.

AU - Ruddy, R.

AU - Shults, M.

AU - Walker, A.

AU - Levick, N.

AU - Brennan, J.

AU - Brown, J.

AU - Dean, J. M.

AU - Hoyle, J.

AU - Maio, R.

AU - Ruddy, R.

AU - Schalick, W.

AU - Singh, T.

AU - Wright, J.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Study objective We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. Methods This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Results Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT. Conclusion Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.

AB - Study objective We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. Methods This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Results Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT. Conclusion Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.

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Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma

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