Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan

Abstract

Purpose Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. Methods This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. Results Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]).Conclusions In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.

A rare case of posttraumatic meningitis presenting with acute hydrocephalus

“…Posttraumatic meningitis is a possible complication of severe TBI. In a large Japanese study of more than 60,000 people only 0.5 % of patients had posttraumatic meningitis [3] . Factors increasing the risk of posttraumatic meningitis are - operative interventions, skull base fractures and CSF leakage.…”

“…Posttraumatic meningitis is a severe complication of traumatic brain injury (TBI) that dramatically increases its mortality [3] . Skull-base fractures increase the risk of posttraumatic meningitis.…”

Incidental Sacral Meningocele in an Elderly Patient Diagnosed After Epidermal Inclusion Cyst Removal: A Case Report

“…However, the incision of a meningocele will lead to CSF leakage. Because CSF leakage can lead to severe sequelae such as meningitis, subdural hematoma, and cerebral venous thrombosis [ 9 , 10 ], corrective procedures should not be performed in the office clinic.…”

Survival outcomes after traumatic brain injury during national academic meeting days in Japan

“…We excluded patients with a maximum head AIS score of 6 (non-survivable injury) or 9 (unspecified injury), those requiring inter-hospital transport, or those who underwent cardiopulmonary arrest upon hospital arrival 13 . Patients who underwent cardiopulmonary arrest were defined as those with a systolic blood pressure (SBP) of 0 mmHg and/or heart rate of 0 bpm on or before hospital arrival 14 . We also excluded cases with missing data on age, sex, Glasgow Coma Scale (GCS) score on arrival, Injury Severity Score (ISS), or survival outcome.…”