{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T15:27:05Z","timestamp":1746804425275,"version":"3.28.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003The clinical signs of base of skull fracture (BSF) are often ambiguous and difficult to identify, but are often used to make decisions on early medical interventions. This study aimed to assess the prevalence of the clinical signs of BSF, their dependency to diagnose this injury and to assess the correlation between the presence of these clinical signs and the severity of head injury and patient outcome.<\/jats:p><jats:p>\n          Materials and Methods\u2003A cross-sectional study was conducted in a tertiary care hospital in South India over a period of 3 years (2020\u20132023). Patients older than 18 years, with radiological or surgical evidence of BSF were monitored for developing the clinical signs including Battle's signs, raccoon's sign, otorrhea, and rhinorrhea. The presence of these clinical signs was correlated with demographical characteristics, patient presentation, complications, and their outcome.<\/jats:p><jats:p>\n          Results\u2003A total of 292 patients were included in the study. The mean age of the cohort was 36.27\u2009\u00b1\u200918.68 years. A total of 55 (18.8%) showed at least one of the four signs of BSF. Raccoon's sign was seen in 9.5% cases, Battle's sign in 5.5%, otorrhea in 5.5%, and rhinorrhea in 2.4% cases. Patients with frontal (p\u2009=\u20090.021) or ethmoid (0.049) fractures and ENT bleeding (p\u2009=\u20090.022) were significantly more likely to present with at least one sign of BSF. The patients who presented with clinical signs were more likely to have a complication during the course of the hospital stay (p\u2009=\u20090.024) than those without clinical signs, including cranial nerve palsy (p\u2009&lt;\u20090.001) and cerebrospinal fluid leak (p\u2009&lt;\u20090.001). The outcome of the patient did not change based on the presence of clinical signs (p\u2009=\u20090.926).<\/jats:p><jats:p>\n          Conclusion\u2003These study results indicate a limited diagnostic value of BSF clinical signs in the South Indian population. Thus, other modalities should be considered for the diagnosis when suspected. These results also discourage the use of the nasal route in all patients with suspected head injury and emphasize that during the nasal aspiration procedure, the use of a rigid device is fundamental to avoid false passage of the aspiration tube from the nasal to the intracranial region.<\/jats:p>","DOI":"10.1055\/s-0044-1787778","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T23:26:31Z","timestamp":1718061991000},"page":"484-489","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Signs of Base of Skull Fracture in the South Indian Population"],"prefix":"10.1055","volume":"19","author":[{"given":"Harsh","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shambhavi","family":"Ranjan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnamurthy","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.nic.2014.03.001","article-title":"Skull base fractures and their complications","volume":"24","author":"K L Baugnon","year":"2014","journal-title":"Neuroimaging Clin N Am"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/00001199-200611000-00009","article-title":"Incidence of traumatic brain injury in the United States, 2003","volume":"21","author":"W Rutland-Brown","year":"2006","journal-title":"J Head Trauma Rehabil"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/JTN.0000000000000392","article-title":"Clinical signs of basilar skull fracture and their predictive value in diagnosis of this injury","volume":"25","author":"C A Solai","year":"2018","journal-title":"J Trauma Nurs"},{"volume-title":"Basilar skull fractures","year":"2023","author":"L V Simon","key":"ref4"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.anclin.2018.09.009","article-title":"Advanced Trauma Life Support\u00ae Update 2019: management and applications for adults and special populations","volume":"37","author":"S M Galvagno Jr","year":"2019","journal-title":"Anesthesiol Clin"},{"issue":"02","key":"ref6","first-page":"77","article-title":"Positive predictive values of selected clinical signs associated with skull base fractures","volume":"44","author":"L Pretto Flores","year":"2000","journal-title":"J Neurosurg Sci"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"100906","DOI":"10.1016\/j.inat.2020.100906","article-title":"A study of clinical presentation and management of base of skull fractures in our tertiary care centre","volume":"23","author":"B Naidu","year":"2021","journal-title":"Interdiscip Neurosurg"},{"volume-title":"The Abbreviated Injury Scale (AIS): 2005, Update 2015","year":"2015","author":"Association for the Advancement of Automotive Medicine (AAAM)","key":"ref8"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"647","DOI":"10.3171\/2015.4.JNS1528","article-title":"Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps","volume":"124","author":"J B Archer","year":"2016","journal-title":"J Neurosurg"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1067\/moe.2000.110032","article-title":"Intracranial placement of a nasogastric tube after severe craniofacial trauma","volume":"90","author":"J Ferreras","year":"2000","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"ref11","first-page":"249","volume-title":"Nervous system trauma","author":"W Wright","year":"2009"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.3340\/jkns.2012.51.5.305","article-title":"Sixth and twelfth cranial nerve palsies following basal skull fracture involving clivus and occipital condyle","volume":"51","author":"S H Kim","year":"2012","journal-title":"J Korean Neurosurg Soc"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/00000433-199812000-00007","article-title":"Intracranial insertion of a nasogastric tube in a case of homicidal head trauma","volume":"19","author":"A Gianelli Castiglione","year":"1998","journal-title":"Am J Forensic Med Pathol"},{"issue":"03","key":"ref14","first-page":"17","article-title":"Basilar skull fractures: clinical and prognostic aspects [in Russian]","author":"A A Potapov","year":"2004","journal-title":"Zh Vopr Neirokhir Im N N Burdenko"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1787778.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T12:10:59Z","timestamp":1730808659000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1787778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":14,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2024,8,27]]},"published-print":{"date-parts":[[2024,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1787778","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"type":"print","value":"1793-5482"},{"type":"electronic","value":"2248-9614"}],"subject":[],"published":{"date-parts":[[2024,6,10]]}}}