Clinical Outcomes and Prognostic Determinants of Surgically Treated Depressed Skull Fracture in Addis Ababa University Neurosurgical Teaching Hospitals: A Prospective Multicenter Observational Study
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Date
2020-10
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Addis Abeba University
Abstract
Background: Depressed skull fracture (DSF) is one of the commonest neurosurgical
emergencies in Ethiopia. The clinical outcome after surgical management and what factors
predict the outcome is not well-studied, especially in low-income countries like Ethiopia. Our
study aimed to assess the clinical outcomes of DSF and identify predictors of the outcome in
surgically treated adult patients.
Methodology: A prospective, multicenter, observational study was undertaken on 197 surgically
treated patients with DSF from June 1, 2018, to June 30, 2020, at four selected neurosurgical
teaching hospitals in Ethiopia. Adult patients with clinically palpable or CT evidence of DSF
who underwent surgery for the primary indication of the DSF were included in this study. Data
on patients‟ socio-demographics, mechanisms of injury, clinical findings at presentation,
imaging, and intraoperative findings, and postoperative course was collected and analyzed. The
outcome was assessed by the extended Glasgow outcome scale (GOS-E): as favorable or
unfavorable. Bivariate analysis was done to identify factors that correlate with the clinical
outcome and multivariate logistic regression analysis was done to identify independent
predictors of the outcome.
Results: The overall clinical outcome was favorable in 81.2% of 197 patients. The mean age of
participants was 27.77 +/- 10.21 years with a male to female ratio of 23.6:1. The most common
mode of injury was violence-related 157 (79.7%). The DSF was compound in 186 (94.4%). Posttraumatic
motor deficit and early posttraumatic seizures were witnessed in 24.4% and 8.1%
respectively. Based on post-resuscitation GCS 182(92.2%) patients had mild TBI, 12(6.1%)
moderate TBI, and only 3(1.5%) were in severe TBI. The most common site of fracture was
frontal bone involved in 103 (52.3%) of cases, followed by parietal bone in 48 (24.4%).
Associated intracranial lesion was identified in 172 (87.3%) of cases. The median days of
hospital stay were 4.7 days. Totally 8(4.1%) patients underwent reoperation and the overall
mortality was 0.5%. In bivariate and multivariate analysis, posttraumatic motor deficit (adjusted
OR 13.8, 95% CI: 4.13-46.17, P=0.000), post-resuscitation GCS ≤13 (adjusted OR 10.36, 95%
CI: 1.93-55.56, P=0.006), pneumocephalus on brain CT scan (adjusted OR 12.93, 95% CI: 3.1253.52,
P=0.000),
hospital
stay
for
≥
3
days
(adjusted
OR
4.39,
95%
CI:
1.18-16.3,
P=0.027)
and
reoperation
(adjusted OR 6.92, 95% CI: 1.091- 43.97, P=0.04) were statistically significant
independent predictors of unfavorable outcome.
Conclusion: The overall outcome of surgical treatment for DSF in this study was favorable. The
presence of motor deficit, post-resuscitation GCS ≤ 13, pneumocephalus, reoperation, and
hospital stays for ≥ 3 days were independent predictors of an unfavorable outcome.
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Keywords
Neurosurgery,Skull Fracture