The association of skull fractures with intracranial Bleeding in blunt head injury

Abstract

Six hundred and seventy five patients were admitted at the Kenyatta National Hospital with blunt head injury in the period between June 1st 2007 and October 12th 2007. Out of this number, three hundred patients with skull fractures were recruited into the study having been admitted into the respective units and fulfilling the inclusion criteria. This prospective study was conducted in the period, with approval from the Ethics and Research Committee of the Kenyatta National Hospital. ~ In the study population, 274 patients ( 91.30/0) were males and 26 patients (8.7%) were females. Out of the total population, 124 patients (41.3%) were unemployed while 84 were self employed (280/0), casual labourers were 54 (18%),20 (6.7%) were students and 16 were formally employed 18 (6%). The causes of injury resulting in the skull fracture were found to be assault (49.7%), RTA (31.7%), falling objects (16%), sporting injuries (1.7%) and others (1%). At presentation" 74.7% of the patients had mild head injury, 150/0 had moderate head injury, 7.7% had severe head injury and 2.7% had critical head injury. Pupilary state was abnormal in 14.70/0 of the patients, neurological deficits were observed in 17.30/0, and signs of basal skull fracture were evident in 20.7% of the patients. Intracranial bleeding was present in 24.30/0 of the patients, presenting as intracerebral bleed in 10.70/0 of the total population, extradural in 70/0, subdural as 3.7%, subarachnoid in 0.3% and combination of bleeds in 2.7%. The location of the bleed was parietal in 18.7%, temporal in 3~/o, and combination in 20/0. Most commonly fractured skull bone was the parietal bone (43%) then basal bones 26%, frontal 21.3~o, occipital 5.30/0, temporal 2.30/0 and multiple bones in 2%. The fracture was simple in 570/0 of the cases, compound linear in 25.30/0, compound depressed in 10.7% and simple depressed in 6.3%. Majority of the patients were treated non-surgically (61.30/0) while the rest (38.7%) were operated upon. By the end of one week of admission, 87. 7~1oof the patients had been discharged, 10.70/0 had died and 1.70/0 were still receiving inpatient care. Upon statistical analysis of the results, there was a positive correlation in the presence of neurological symptoms in patients with skull fractures and the presence of intracranial bleeding. The results were in conformity with earlier studies done internationally. The site of the bleeding could however not be reliably determined by the location or type of fracture