Predicting dural tear in patients will skull fractures secondary to assault

Abstract

Aim: Skull fractures of the calvarium associated with a dural tear are regarded as neurosurgical emergencies to prevent potentially devastating infective complications. We aimed to determine the significance of pre-operative clinical and radiological variables in predicting dural tear in 135 patients admitted over a 2 year period with skull fractures secondary to assault whom went for operative intervention. Methods: Retrospective data analysis of 135 patients admitted with skull fractures secondary to assault from January 2015–December 2016 was performed. Medical records were analyzed for patient demographics, mechanism of injury, CT scan findings, pre-operative suspicion including evidence for this suspicion of a dural tear, operative confirmation of a dural tear, and Glasgow Outcome Score. Management involved surgery with antibiotic cover. Results: Considering the mechanism of injury being assaulted with a brick was significantly associated with the absence of a dural tear and being stabbed in the head with significantly associated with the presence of a dural tear (p = 0.02). On bivariate analysis having a depressed skull fracture (p = 0.002), pneumocephalus (p = 0.02) or an intracerebral hematoma (p = 0.001) were each statistically associated with the operative confirmation of a dural tear. Neither the combined presence of a skull fracture with an acute subdural hematoma or an intracerebral contusion was statistically associated with an intra-operative dural tear. Conclusion: In patients with a skull fracture secondary to assault considering the mechanism of injury being assaulted with a brick significantly excluded, and being stabbed in the head significantly predicted, the intra-operative finding of a dural tear. Considering pre-operative radiology having a depressed skull fracture, pneumocephalus, or intracerebral hematoma were each significant predictive variables of there being an intra-operative dural tear.