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A Journal on Neurosurgery

Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651

Frequency: Bi-Monthly

ISSN 0390-5616

Online ISSN 1827-1855


Journal of Neurosurgical Sciences 2000 June;44(2):77-83


Positive predictive values of selected clinical signs associated with skull base fractures

Pretto Flores L., De Almeida C. S., Casulari L. A.

Neurosurgery Unit, Hospital ­de Base do Distrito Federal (UNC-HBDF), Brasilia, Brasil

Back­ground. ­The ­goal of ­this ­study ­was to deter­mi­nate ­the pos­i­tive pre­dic­tive val­ues of select­ed clin­i­cal ­signs ­for ­skull ­base frac­tures ­and asso­ciat­ed intra­cra­ni­al ­lesions.
Meth­ods. Experi­men­tal ­design: Clin­i­cal ­and radio­log­i­cal ­data ­were col­lect­ed pros­pec­tive­ly ­for ­all ­patients ­with select­ed clin­i­cal ­signs of ­skull ­base frac­tures, ­and ­their admis­sion cri­te­ria ­were: 1) ­recent ­head inju­ry sto­ry; 2) pres­ence of ­one or ­more of fol­low­ing clin­i­cal ­signs: uni­lat­er­al or bilat­er­al ble­phar­o­hae­mat­o­ma, ­bloody otor­rhea, ­and ­Battle’s ­sign. Set­ting: Emer­gen­cy ser­vice of a insti­tu­tion­al hos­pi­tal. ­Patients: ­One hun­dred for­ty ­two ­patients ­with ­the select­ed clin­i­cal ­signs ­for ­skull ­base frac­ture.
­Results. Fron­tal ­bone frac­tures ­were ­the ­most fre­quent in ­patients ­with select­ed clin­i­cal ­signs. ­Battle’s ­sign (100%) ­and uni­lat­er­al ble­phar­o­hae­mat­o­ma (90%) ­were ­the ­signs ­with high­er pos­i­tive pre­dic­tive val­ues ­for ­skull ­base frac­tures; bilat­er­al ble­phar­o­hae­mat­o­ma (70%) ­and ­bloody otor­rhea (70%) ­were ­those ­with ­less val­ues. ­The pos­i­tive pre­dic­tive val­ues of ­the select­ed ­signs ­for intra­cra­ni­al ­lesions (­acute extrad­u­ral hae­mat­o­ma, pneu­mo­ceph­al­us, ­brain con­tu­sion, ­brain swell­ing, ­and ­acute sub­du­ral hae­mat­o­ma) ­were: uni­lat­er­al ­and bilat­er­al ble­phar­o­hae­mat­o­ma ­with pos­i­tive pre­dic­tive val­ues of 85% ­and 68%, respec­tive­ly; ­Battle's ­sign ­was 66%; ­and ­bloody otor­rhea ­was 46%. ­For ­patients at admis­sion on ­the 13-15 Glas­gow ­Coma ­Scale ­only, ­the pos­i­tive pre­dic­tive val­ues ­for ­that intra­cra­ni­al ­lesions ­were: ble­phar­o­hae­mat­o­ma=78%; ­Battle's ­sign=66%; ­and ­bloody otor­rhea=41%.
Con­clu­sions. Our ­data dem­on­strat­ed ­that ­the select­ed ­signs of ­skull ­base frac­tures ­have ­high pos­i­tive pre­dic­tive val­ues ­for ­the pres­ence of ­skull frac­ture ­and intra­cra­ni­al ­lesions, ­even in ­those ­patients clas­si­fied in ­the Glas­gow ­Coma ­Scale ­between 13 ­and 15. ­This indi­cates ­that ­all ­patients ­with ­the select­ed clin­i­cal ­signs ­should be sub­mit­ted to com­pu­ter­ized tomog­ra­phy of ­skull ­and ­with ­bone win­dow, ­with ­the ­aim to ­detect asso­ciat­ed ­lesions.

language: English


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