title: The association between skull bone fractures and outcomes in patients with severe traumatic brain injury.
abstract: BACKGROUND
  In traumatic brain injury (TBI), computed tomography (CT) provides a good assessment of anatomic pathologic findings and the prognostic value of CT characteristics has been well discussed. However, few studies have focused on skull bone fracture and its clinical prognostic importance. Hence, this study aims to evaluate the effects of skull bone fracture on patients with severe TBI admitted to the emergency unit.
  
  
  METHODS
  We reviewed the medical records of patients with isolated severe TBI admitted to the emergency unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on the presence of skull bone fracture identified by the CT scan while in the emergency unit. Mann-Whitney U test and a Student's t test were used to identify the differences between the two groups, whereas logistic regression was applied to determine any significant differences found in the statistical analysis.
  
  
  RESULTS
  A total of 197 patients were signed up in our study. Based on the presence of skull bone fracture on CT scan at emergency department, 92 patients (46.7%) comprised the skull bone fracture group and 59 patients (64.1%) of these died. One hundred five patients (53.3%) comprised the nonskull bone fracture group, of which 33 patients (31.4%) died. There is significant difference between the two groups (p = 0.004).
  
  
  CONCLUSIONS
  This study shows that skull bone fracture is a mortality risk factor for patients with isolated severe blunt TBI.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Tseng
authors.forename: Hong-Mo
authors.initials: HM
authors.lastname: Shih
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Su
authors.forename: Hong-Wen
authors.initials: HW
authors.lastname: Chen
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Hsiao
authors.forename: I-Chuan
authors.initials: IC
authors.lastname: Chen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*