Predicting dural tear in compound depressed skull fractures: a prospective multi-center correlational study.

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Predicting dural tear in compound depressed skull fractures: a prospective multi-center correlational study.

World Neurosurg. 2018 Mar 24;:

Authors: Salia SM, Mersha HB, Aklilu AT, Baleh AS, Lund-Johansen M

Abstract
BACKGROUND: Compound depressed skull fractures (DSF) are neurosurgical emergencies. Pre-operative knowledge of dural status is indispensable for treatment decision. This study aims to determine predictors of dural tear from clinical and imaging characteristics in patients with compound DSF.
PATIENTS AND METHODS: The authors conducted a prospective, multi-center correlational study in neurosurgical hospitals in Addis Ababa, Ethiopia. Patients (n=128) operated from January 1 to October 31, 2016 were included. Clinical, imaging and intra-operative findings were evaluated. Univariate and multivariate analysis were used to establish predictors of dural tear. A logistic regression model was developed to predict the probability of dural tear. Model validation was done using the Receiver Operating Characteristic (ROC) curve.
RESULTS: Of 128 patients, dural tear was seen in 55.5%. Demography, injury mechanism, clinical presentation, and site of DSF had no significant correlation with dural tear. In univariate and multivariate analysis, depth of fracture depression (OR=1.3, p<0.001), pneumocephalus (OR=2.8, p=0.005) and brain contusions/intra-cerebral hematoma (ICH) (OR=5.5, p<0.001) had significant correlation with dural tear. We developed a logistic regression model (diagnostic test) to calculate the probability of dural tear. Using the ROC curve, we determined the cutoff value for a positive test giving the highest accuracy to be 30% with a corresponding sensitivity and specificity of 93.0% and 43.9%, respectively.
CONCLUSIONS: We conclude that dural tear in compound DSF can be predicted with 93.0% sensitivity using pre-operative findings and may guide treatment decision in resource limited settings where the risk of extensive cranial surgery overweight the benefit.

PMID: 29588245 [PubMed - as supplied by publisher]

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