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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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