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Clinical Signs of Basilar Skull Fracture and Their Predictive Value in Diagnosis of This Injury

Solai, Cibele Andres, MSN, RN; Domingues, Cristiane de Alencar, PhD, RN; Nogueira, Lilia de Souza, PhD, RN; de Sousa, Regina Marcia Cardoso, PhD, RN

doi: 10.1097/JTN.0000000000000392

Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess the performance of early and late (within 48 hr posttrauma) signs for BSF diagnosis and to verify the correlation between the presence of these signs and head injury severity. We conducted a prospectively designed follow-up study at a referral hospital for trauma care in Sao Paulo, Brazil, and performed structured observations for 48 hr post-blunt head injury in patients aged 12 years or older. The following signs of BSF were considered: raccoon eyes, Battle's sign, otorrhea, and rhinorrhea. Among the 136 enrolled patients (85.3% male; mean age 40 ± 21.4 years), 28 patients (20.6%) had BSF. The clinical signs for the early or late detection of BSF had low accuracy (55.9% vs. 43.4%), specificity (52.8% vs. 30.5%), and positive predictive value (25.7% vs. 27.1%). However, the presence of these signs was correlated to head injury severity, indicated by the Glasgow Coma Scale (p = .041) and Maximum Abbreviated Injury Scale–Head region (p = .002). In view of the low accuracy of these signs, resulting low clinical value of their presence, and their high sensitivity in the late stage, the study results contraindicate the value of BSF signs for making decisions about using the nasal route for the introduction of catheters and tubes in initial trauma care.

School of Nursing, University of São Paulo, Sao Paulo, SP, Brazil (Mss Solai and Drs Nogueira and de Sousa); and All Trauma, Sao Paulo, SP, Brazil (Dr Domingues).

Correspondence: Cristiane de Alencar Domingues, PhD, RN, Rua Engenheiro Agrônomo Guaracy Ribeiro Monteiro, 345, Apto 188, Ribeirão Preto 14026-574, SP, Brazil (

The authors declare no conflicts of interest.

Copyright © 2018 by the Society of Trauma Nurses.