Meningitis Following Trauma to the Head and Face

Appelbaum, Emanuel

doi:10.1001/jama.1960.03020340036010

Cited by 90 publications

(22 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,20 The reported incidence of posttraumatic meningitis range from 3 to 50 percent, but the incidence tends to be higher when the leaks persist beyond 7 days. 21 Therefore, exploration and dural repair are recommended if the cerebrospinal fluid leak is present for more than 7 days after the injury. As a general principle, patients with persisting cerebrospinal fluid leaks that are refractory to conservative management can undergo cisternography to localize the leaks before dural exploration.…”

Section: Discussionmentioning

confidence: 99%

Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Chen

Mardini

et al. 2006

Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

Involvement of the nasofrontal duct and persistence of cerebrospinal fluid leaks are two key determinants of the treatment algorithm. The amount of displacement of the posterior table has not been found to be a key determinant of the need for surgical intervention. When the sinus is to be obliterated, partial obliteration can achieve a good result, with limited sinus complication and minimal donor-site morbidity.

show abstract

Section: Discussionmentioning

confidence: 99%

Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Chen

Mardini

et al. 2006

Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…18,21,27 Posttraumatic meningitis is associated with considerable morbidity and mortality. 1,2,23,32 Typically, a fracture involving the skull or neighboring facial structures may produce a breach in the meningeal layer and can result in CSF rhinorrhea, CSF otorrhea, or both. 24 Cerebrospinal fluid leaks following skull base fractures develop in approximately 10%-30% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the development of meningitis has shown to contribute substantially to increased mortality and morbidity in such patients. 1,2,23,32 Various factors that are associated with the development of posttraumatic meningitis include skull fractures, facial fractures (mainly involving the paranasal sinuses), otological injuries, development of CSF fistulas, and pneumocephalus. 6,8,13,15,16,20,25,31 Typically, fractures of the skull or facial bones may lead to the formation of CSF fistulas, which in turn increase the likelihood of meningitis.…”

mentioning

confidence: 99%

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

Sonig¹,

Thakur²,

Chittiboina³

et al. 2012

FOC

View full text Add to dashboard Cite

Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not undergo any neurosurgical intervention was further categorized into quartile groups, and a regression model was created to analyze various factors responsible for escalating the overall cost of the hospital stay. Results A total of 382,267 inpatient admissions for head injury were analyzed for the 2005–2009 period. Meningitis was reported in 0.2% of these cases (708 cases). Closed skull base fractures, open skull base fractures, cranial vault fractures, and maxillofacial fractures were reported in 20,524 (5.4%), 1089 (0.3%), 5064 (1.3%), and 88,649 (23.2%) patients, respectively. Among these patients with fractures, meningitis was noted in 0.17%, 0.18%, 0.05%, and 0.10% admissions, respectively. Cerebrospinal fluid rhinorrhea was reported in 453 head injury patients (0.1%) and CSF otorrhea in 582 (0.2%). Of the patients reported to have CSF rhinorrhea, 35 (7.7%) developed meningitis, whereas in the cohort with CSF otorrhea, 15 patients (2.6%) developed meningitis. Cerebrospinal fluid rhinorrhea (p < 0.001, OR 22.8, 95% CI 15.6–33.3), CSF otorrhea (p < 0.001, OR 9.2, 95% CI 5.2–16.09), and major neurosurgical procedures (p < 0.001, OR 5.6, 95% CI 4.8–6.5) were independent predictors of meningitis. Further, CSF rhinorrhea (p < 0.001, OR 2.0, 95% CI 1.6–2.7), CSF otorrhea (p < 0.001, OR 2.3, 95% CI 1.9–2.7), and posttraumatic meningitis (p < 0.001, OR 3.1, 95% CI 2.5–3.8) were independent factors responsible for escalating the cost of head injury in cases not requiring any major neurosurgical intervention. Conclusions Cerebrospinal fluid rhinorrhea and CSF otorrhea are independent predictors of posttraumatic meningitis. Furthermore, meningitis and CSF fistulas may independently lead to significantly increased cost of hospitalization in head injury patients not undergoing any major neurosurgical intervention.

show abstract

“…There are reports about high mortality rates from 29% to 57.9% due to this infection [3][4][5]. Previous studies revealed that basilar skull fracture and cerebrospinal fluid (CSF) leakage were also associated with posttraumatic meningitis [6,7]. In addition, the length of time of external ventricular drainage, emergency operation, and operation time over 4.5 h was also reported to relate to the occurrence of postoperative meningitis in patients undergoing a neurosurgical operation [8,9].…”

Section: Introductionmentioning

confidence: 99%

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

Katayama

Kitamura

Kiyohara

et al. 2019

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

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.

show abstract

Meningitis Following Trauma to the Head and Face

Cited by 90 publications

References 8 publications

Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

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

Contact Info

Product

Resources

About