Isolated Basilar Skull Fracture: Outcomes and Predictors of Readmission

Abstract

Objectives:

Outcomes in pediatric and adult patients with isolated basilar skull fracture.

Methods:

Cases of isolated basilar skull fracture were identified in the California Office of Statewide Health Planning and Development (OSHPD) database. In-hospital and 90-day rates of meningitis and cerebrospinal fluid (CSF) leak were assessed. Determinants of 30-day readmission were evaluated using multivariate logistic regression.

Results:

5,223 pediatric and 7,421 adult patients met inclusion criteria. Most patients had a length of stay greater than one day (64.3% pediatric and 77.5% adult). In-hospital rates of meningitis (0.41% and 0.55%) and CSF leak (2.24% and 1.75%) were similar among children and adults, respectively. Rates of 90-day meningitis (0.24% and 0.37%) and CSF leak (0.43% and 0.40%) were also similar. 30-day readmission was 3.94% for children compared to 12.4% for adults. For pediatric and adult patients, extra-axial hematoma (odds ratio [OR] 1.73 and 1.57) and comorbidities (OR 2.18 and 1.50) were associated with significant increases in 30-day readmission (p<0.001). Loss of consciousness of greater than one hour (OR 2.45, p<0.001), and CSF leak (OR 2.80 p=0.002) was also associated with significant increases in pediatric readmissions. No association between length of stay and the likelihood of readmission was observed.

Conclusions:

Meningitis and CSF leaks following isolated basilar skull fractures are rare in both children and adults. This study found no association between length of stay and likelihood of readmission. This suggests that, in the absence of CSF leak or other complication, extended inpatient monitoring may be unwarranted as a means to reduce complications and readmissions.