Evaluating patient epidemiology and clinical practice on the outcome of patients admitted with skull fractures secondary to assault

Author(s): Adrian Kelly* and Patrick Lekgwara

Objectives: Patients whom incur skull fractures secondary to assault are a common referral to the Department of Neurosurgery at Dr. George Mukhari Academic Hospital in Pretoria, South Africa. Our study aimed to statistically evaluate patient epidemiology and our clinical practice in relation to patient outcome. Methods: A retrospective chart review of 246 consecutively admitted patients with skull fractures secondary to assault from January 2015-December 2016 was performed. Medical records were analyzed for patient demographics and key aspects of our clinical practice which included patient age, gender, employment status, type of referral, days from injury until admission, mechanism of injury, severity of head injury, CT scan findings, days from admission until operative intervention, type of surgery performed, in-patient sepsis rate, length of hospital stay and Glasgow Outcome Score. Results: On univariate analysis the variables that demonstrated an increased chance of a patient having a favorable outcome were having a mean age of 30 years (p=0.01), being referred from a local clinic (p<0.001), being assaulted with a brick (p=0.02), having a mild head injury (p<0.001), having an extradural haematoma (p<0.001), having a craniectomy with/without a dural repair performed (p<0.001), and having a mean length of hospital stay of 9 days (p<0.05). The variables associated with a patient having an unfavorable outcome were being above the age of 40 years (p=0.003), being referred from the scene of the assault (p<0.001), being assaulted by the community (p=0.02), having a severe head injury (p<0.001), having an acute subdural haematoma or contusion (p<0.001), having a decompressive craniectomy performed (p<0.001) and having a mean length of hospital stay of 13-18 days (p<0.05). Conclusion: Our study demonstrated that the majority of the significant prognostic variables were determined in the pre-hospital setting. Our study highlights the importance of primary prevention as the major consideration that should be targeted to prevent the morbidity and mortality associated with this social problem