title: Risk of death in patients with post-traumatic cerebrospinal fluid leakage--analysis of 1773 cases.
abstract: BACKGROUND
  Post-traumatic cerebrospinal fluid (CSF) leakage is one of the most troublesome conditions associated with head trauma. CSF fistulae, meningitis/central nervous infection, or even death may accompany it. Few studies have discussed post-traumatic CSF leakage as a risk factor in mortality following head trauma. We conducted this cohort study to examine the issue.
  
  
  METHODS
  We reviewed the records in the Taiwan Traumatic Brain Injury (TBI) Registry System between 1993 and 2008. The study group included patients with acute TBI and post-traumatic CSF leakage, and the control group included cases with TBI but without CSF leakage, selected randomly at a 5:1 ratio with respect to the study group. The demographic data, Glasgow Coma Scale, brain computerized tomography, association of skull fractures and intracranial lesions, and 1-year mortality rates between these two cohorts were reviewed meticulously and analyzed statistically.
  
  
  RESULTS
  Of 174,236 cases, 1773 with post-traumatic CSF leakage were included in the study group, and 8865 cases in the control group. Of the total 10,638 sampled cases, 406 (3.8%) died during the 1-year follow-up period, 159 (9.0%) cases in the CSF leakages group, and 247 (2.8%) in the control group. The patients with CSF leakage had a significantly higher mortality rate within 1 year (adjusted hazard ratio = 1.44, p < 0.001) than those without. We divided the CSF leakage group into three subgroups: otorrhea (n = 568), rhinorrhea (n = 302), and tension pneumocephalus (n = 903). The mortality rates were 8.5% (48/568) in the otorrhea subgroup, 10.9% (33/302) in the rhinorrhea subgroup, and 8.6% (78/903) in the tension pneumocephalus subgroup. The cases with CSF rhinorrhea had a significantly higher mortality rate than the other two subgroups (p < 0.05). All three subgroups had significantly higher mortality rates than the control group during the 1-year follow-up period (adjusted hazard ratios = 2.29, 1.35, and 1.32 in the rhinorrhea, tension pneumocephalus, and otorrhea subgroups, respectively).
  
  
  CONCLUSIONS
  Post-traumatic CSF leakages had higher mortality rates than those without CSF leakages in TBI cases, and the cases with CSF rhinorrhea had worse outcomes compared with CSF leakages with pneumocephalus or otorrhea.
authors.affiliation: Department of Neurosurgery, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Kuo-Hsing
authors.initials: KH
authors.lastname: Liao
authors.affiliation: Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
authors.forename: Jia-Yi
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Mathematics, Soochow University, Taipei, Taiwan, ROC.
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC.
authors.forename: Tai-Ngar
authors.initials: TN
authors.lastname: Lui
authors.affiliation: Graduate Institute of Neural Regenerative Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
authors.forename: Kai-Yun
authors.initials: KY
authors.lastname: Chen
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: David Hung Tzang
authors.initials: DH
authors.lastname: Yen
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: mjjeng@vghtpe.gov.tw.
authors.forename: Mei-Jy
authors.initials: MJ
authors.lastname: Jeng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D065634:Cerebrospinal Fluid Leak / Q000401:mortality*; D020209:Cranial Nerve Injuries / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012887:Skull Fractures / Q000150:complications; D015599:Trauma Severity Indices
keywords: cerebrospinal fluid; leakage; mortality; skull fracture; traumatic brain injury