Skull fracture: an indicator of life-threatening injury or a predictor of intracranial injury?
Keywords:skull bones fracture, intracranial lesions, severity of traumatic brain injury, forensic examination
Purpose. To provide arguments that would allow to bring existing today in forensic medicine evaluation of the severity of traumatic brain injury (TBI) to clinical practice.
Materials and methods. A retrospective analysis of 280 cases histories of patients been treated for TBI was provided, and 131 autopsy protocols of dead from severe TBI. Clinical evaluation of TBI severity was made according to the Glasgow Coma Scale and TBI classification. The data were statistically processed using c2.
Results. The analysis of skull fractures localization showed that mild TBI is characterized by fracture of one bone — in 38 (78.9%) cases and skull vault — in 45 (91.8%). At moderate and severe TBI fractures are localized in several bones — in 18 (50%) cases spreading on the skull base in 5 (13.8%). 57.6% skull fractures were observed in patients with mild TBI. Fractures in patients with mild TBI and concomitant intracranial injuries determines the duration of post-contusion symptoms (c2=4,9; p=0,026). CT is an obligatory examination at head trauma, also it allows to objectify the cause of the prolonged post-contusion syndrome at expert assessment of TBI severity.Conclusions. 1. Closed scull fracture as a damage just of the bones in most cases can not be regarded as the immediate cause of death. 2. Linear scull fracture is a possible risk factor for intracranial lesions, but not a predictor of TBI severity. 3. Open penetrating head injury, multiple and comminuted fractures, skull base fractures, as well as pneumocephalus, liquorrhea indicate forming of life-threatening condition of the victim. 4. Linear fractures at mild TBI and associated intracranial injury cause prolonged existence of post-contusion symptoms.
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Copyright (c) 2013 Eugene Pedachenko, Vasyl Burchynskyi, Nikolay Kadzhaya, Andriy Huk, Andrey Diadechko, Dmytro Kuzmenko, Andrii Boliukh, Oleksandr Gotin, Oksana Skobska, Oleg Robak
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