LAUSR

Cerebrospinal fluid (CSF) leaks occur in association with skull base fractures (SBF) among head-trauma patients. Using a national database, management trends of CSF-leaks associated with SBF in pediatric patients were examined. Weighted data were analyzed from the Nationwide Inpatient Sample 2000-2014 and all pediatric head-trauma patients having a diagnosis of SBF identified. Injury severity was mapped using the Abbreviated Injury Severity (AIS) scale and categorized as mild: AIS < 3, moderate: AIS = 3, and severe: AIS >3. Trends over time and across 5-yr age groups were examined at a significance level of P < .05. A total of 699 173 SBF cases were diagnosed, representing 23.25% of all pediatric head-trauma cases. The majority were closed-SBF (93.14%) and involved male patients (68.60%), and mean patient age was 11.25 yr (SD = 6.49). The median AIS-injury score was 3.0. Severe TBI was more common among 15 to 19 yr olds (P < .001). Overall, CSF-leaks occurred in 2.10%, were more common in older children versus under-5 yr olds (P < .05), and were mostly managed conservatively with fewer patients requiring duraplasty (8.48%) and/or lumbar-drain placement (9.54%). The requirement for nonconservative management, including duraplasty (OR = 5.53; 95% CI = 1.58–19.37; P < .001) and lumbar-drain placement (OR = 2.64; 95% CI = 1.06–6.60; P = .03), was higher among 15 to 19 versus under-5 yr olds. The risk of bacterial meningitis in patients with CSF-leaks was slightly increased among under-5 yr olds compared to older children (P < .05). In-patient mortality associated with SBF was 4.68%, was higher among 15 to 19 versus under-5 yr olds (6.55% vs 3.44%, P < .001) and in open versus closed SBF (16.07% vs 3.84%, P < .001), and decreased significantly across time from 5.09% in 2000 to 3.75% in 2014 (P < .001). The decline in mortality seen across all age groups was significant only in under-5 and in 15 to 19 yr olds (P = .02 and .03, respectively). There was no increased mortality associated with CSF-leaks (P = .65). CSF-leaks occurring among pediatric head-trauma patients are mostly managed conservatively. Younger children may be at an increased risk of meningitis following CSF-leaks.