Jain Harsh, Ranjan Shambhavi, Ganesh Krishnamurthy
Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Asian J Neurosurg. 2024 Jun 10;19(3):484-489. doi: 10.1055/s-0044-1787778. eCollection 2024 Sep.
The clinical signs of base of skull fracture (BSF) are often ambiguous and difficult to identify, but are often used to make decisions on early medical interventions. This study aimed to assess the prevalence of the clinical signs of BSF, their dependency to diagnose this injury and to assess the correlation between the presence of these clinical signs and the severity of head injury and patient outcome. A cross-sectional study was conducted in a tertiary care hospital in South India over a period of 3 years (2020-2023). Patients older than 18 years, with radiological or surgical evidence of BSF were monitored for developing the clinical signs including Battle's signs, raccoon's sign, otorrhea, and rhinorrhea. The presence of these clinical signs was correlated with demographical characteristics, patient presentation, complications, and their outcome. A total of 292 patients were included in the study. The mean age of the cohort was 36.27 ± 18.68 years. A total of 55 (18.8%) showed at least one of the four signs of BSF. Raccoon's sign was seen in 9.5% cases, Battle's sign in 5.5%, otorrhea in 5.5%, and rhinorrhea in 2.4% cases. Patients with frontal ( = 0.021) or ethmoid (0.049) fractures and ENT bleeding ( = 0.022) were significantly more likely to present with at least one sign of BSF. The patients who presented with clinical signs were more likely to have a complication during the course of the hospital stay ( = 0.024) than those without clinical signs, including cranial nerve palsy ( < 0.001) and cerebrospinal fluid leak ( < 0.001). The outcome of the patient did not change based on the presence of clinical signs ( = 0.926). These study results indicate a limited diagnostic value of BSF clinical signs in the South Indian population. Thus, other modalities should be considered for the diagnosis when suspected. These results also discourage the use of the nasal route in all patients with suspected head injury and emphasize that during the nasal aspiration procedure, the use of a rigid device is fundamental to avoid false passage of the aspiration tube from the nasal to the intracranial region.
颅底骨折（BSF）的临床体征往往不明确且难以识别，但常被用于早期医疗干预的决策。本研究旨在评估BSF临床体征的发生率、其对诊断该损伤的依赖性，并评估这些临床体征的存在与头部损伤严重程度及患者预后之间的相关性。
在印度南部一家三级护理医院进行了一项为期3年（2020 - 2023年）的横断面研究。对年龄大于18岁、有BSF放射学或手术证据的患者进行监测，观察是否出现包括乳突部瘀斑（Battle征）、眶周瘀斑（熊猫眼征）、耳漏和鼻漏等临床体征。这些临床体征的出现与人口统计学特征、患者表现、并发症及其预后相关。
本研究共纳入292例患者。队列的平均年龄为36.27±18.68岁。共有55例（18.8%）出现了至少一种BSF的四种体征之一。熊猫眼征见于9.5%的病例，Battle征见于5.5%，耳漏见于5.5%，鼻漏见于2.4%的病例。额叶（P = 0.021）或筛骨骨折（0.049）以及耳鼻喉出血（P = 0.022）的患者出现至少一种BSF体征的可能性显著更高。出现临床体征的患者在住院期间发生并发症的可能性（P = 0.024）高于无临床体征的患者，包括颅神经麻痹（P < 0.001）和脑脊液漏（P < 0.001）。患者的预后并未因临床体征的存在而改变（P = 0.926）。
这些研究结果表明，在印度南部人群中，BSF临床体征的诊断价值有限。因此，当怀疑有BSF时，应考虑其他诊断方法。这些结果也不主张对所有疑似头部损伤的患者采用经鼻途径，并强调在经鼻吸引操作过程中，使用硬质器械对于避免吸引管从鼻腔误插入颅内区域至关重要。
