Risks, costs, and outcomes of cerebrospinal fluid leaks after pediatric skull fractures: a MarketScan analysis between 2007 and 2015

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Skull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors queried the MarketScan database (2007–2015), identifying pediatric patients (age &lt; 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p &lt; 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p &lt; 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p &lt; 0.0001). Compared with the non–CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p &lt; 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p &lt; 0.0001; OR 7.0; 95% CI 3.6–13.6), meningitis (5.5% vs 0.3%, p &lt; 0.0001; OR 22.4; 95% CI 11.2–44.9), nonroutine discharge (6.9% vs 2.5%, p &lt; 0.0001; OR 2.9; 95% CI 1.7–5.0), and readmission (24.7% vs 8.5%, p &lt; 0.0001; OR 3.4; 95% CI 2.5–4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p &lt; 0.0001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.</jats:p></jats:sec>

Evolution of paediatric head trauma patients with CT; The requirement of computed tomography in children with head injury: a cross-sectional study

“…It is common for patients with open skulls to have pathology in cranial CT. In the presence of a visible cranial pathology, cranial CT imagining is to investigate the presence of another pathology that is not visible below [14,15]. We think that there does not exist any difference between the patients that pathological findings were observed or not in the cranial CT statistically because this pathology was rarely observed in our patient group.…”

Treatment Patterns and Health Care Resource Utilization of Iatrogenic Spinal Cerebrospinal Fluid Leaks in the United States

“…6,7 Although CSF leaks can occur spontaneously 2,8 or iatrogenically after manipulation of the dura mater, postprocedural CSF leaks have been associated with the longer hospitalizations and more readmissions, and account for up to 10% of the total costs associated with neurosurgical procedures. 9,10 Previous studies have reported cost burdens of postoperative CSF leaks between $41,000 and 50,000 per affected patient. 9,[11][12][13] This increased health care resource utilization (HCRU) is important given the increasing scrutiny on medical expenditure in the United States.…”

“…9,10 Previous studies have reported cost burdens of postoperative CSF leaks between $41,000 and 50,000 per affected patient. 9,[11][12][13] This increased health care resource utilization (HCRU) is important given the increasing scrutiny on medical expenditure in the United States.…”