Neurosurg Focus. 2019 Nov 1;47(5):E10. doi: 10.3171/2019.8.FOCUS19543.
Skull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.
The authors queried the MarketScan database (2007-2015), identifying pediatric patients (age < 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.
The authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p < 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p < 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p < 0.0001). Compared with the non-CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p < 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p < 0.0001; OR 7.0; 95% CI 3.6-13.6), meningitis (5.5% vs 0.3%, p < 0.0001; OR 22.4; 95% CI 11.2-44.9), nonroutine discharge (6.9% vs 2.5%, p < 0.0001; OR 2.9; 95% CI 1.7-5.0), and readmission (24.7% vs 8.5%, p < 0.0001; OR 3.4; 95% CI 2.5-4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p < 0.0001).
The authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.
儿童头部钝器伤后常发生颅骨骨折。CSF 漏是颅骨骨折的一种罕见但严重的并发症；然而，关于儿童人群中颅骨骨折后发生 CSF 漏的风险，几乎没有证据。在这项流行病学研究中，作者调查了 CSF 漏的危险因素及其对儿童颅骨骨折结局的影响。
作者查询了 MarketScan 数据库（2007-2015 年），确定了有颅骨骨折和 CSF 漏诊断的儿科患者（年龄<18 岁）。颅骨骨折按位置（基底、穹窿、面部）和严重程度（开放性、闭合性、多发性、伴有脑或血管损伤）进行分类。使用描述性统计和假设检验比较基线特征、并发症、质量指标和成本。
作者确定了 13861 名因颅骨骨折住院的儿科患者，其中 1.46%（n=202）发生了 CSF 漏。在颅骨骨折伴 CSF 漏的患者中，118 例（58.4%）表现为耳漏，84 例（41.6%）表现为鼻漏。发生 CSF 漏的患者年龄较大（10.4 岁比 8.7 岁，p<0.0001），更常见颅底（n=183）和多发性（n=22）颅骨骨折（p<0.05）。这些患者也更频繁地接受神经外科干预（24.8%比 9.6%，p<0.0001）。与非 CSF 漏组相比，CSF 漏组患者的平均住院时间更长（9.6 天比 3.7 天，p<0.0001），且更易出现神经功能缺损（5.0%比 0.7%，p<0.0001；OR 7.0；95%CI 3.6-13.6）、脑膜炎（5.5%比 0.3%，p<0.0001；OR 22.4；95%CI 11.2-44.9）、非常规出院（6.9%比 2.5%，p<0.0001；OR 2.9；95%CI 1.7-5.0）和再入院（24.7%比 8.5%，p<0.0001；OR 3.4；95%CI 2.5-4.7）。CSF 漏患者在 90 天时的总费用平均为 81206 美元，而无 CSF 漏患者为 32831 美元（p<0.0001）。
作者发现，1.46%的儿童颅骨骨折患者发生 CSF 漏，颅骨骨折与神经外科干预率显著增加以及 90 天时脑膜炎、医院再入院和神经功能缺损的风险增加相关。颅骨骨折的儿科患者在就诊时和 90 天时还经历了更长的平均住院时间和更高的医疗保健费用。
