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Short-term outcomes of skull fracture

A population-based study of survival and neurologic complications

Department of Neurosciencesw, School of Medicine, University of California, San Diego, CA, University of Pittsburgh Medical School, Pittsburgh, PA. (Dr. Wiederbolt)
School of Public Health, University of Texas, Houston, TX, Mayo Clinic and Foundation, Rochester, MN. (Dr. Annegers)
Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN. (Dr. Melton and Mr. Ilstrup)
Department of Neurology, Mayo Clinic and Foundation, Rochester, MN. (Dr. Grabow)
Department of Neurologic Surgery, Mayo Clinic and Foundation, Rochester, MN. (Dr. Laws)

All Olmsted County, Minnesota, residents who experienced brain injury from 1935 through 1979 were identified and their medical records reviewed for survival and neurologic outcome. Minimum inclusion criteria included loss of consciousness or post-traumatic amnesia or neurologic evidence of brain injury or skull fracture. Of 4,660 cases identified, skull fractures were observed in 28%. Over half of brain-injured patients who died did so within 24 hours of trauma; among 1-day survivors, subsequent survival was moderately impaired, especially in older individuals. Mortality was lowest in subjects without a skull fracture and increased with fracture severity. Associated neurologic injuries, complications, and deficits were generally more common in patients with skull fracture than those without and were much more frequent with more severe skull fractures. The types of neurologic deficits differed little between those with and without fractures, except that subjects with complicated skull fractures had higher proportions of special sensory deficits and multiple deficits.

Address correspondence and reprint requests to Dr. Melton, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Supported in part by research grants NS-16308 and AM-30582 from the National Institutes of Health.

Presented in part at the thirty-ninth annual meeting of the American Academy of Neurology, New York, NY, April 1987.

Received August 17, 1987. Accepted for publication in final form July 1, 1988.