ABSTRACTS

skull fracture, pediatric;

cranial nerves

Basilar skull fractures in childhood with cranial nerve involvement Kitchens JL, Groff DB, Nagarij HS, et al

J Pediatric Surg 26:992-994 Aug 1991

In this retrospective review of 73 pediatric patients with basilar skull fractures, 17 patients (23%) had associated cranial nerve palsies. Eight patients had multiple cranial nerve deficits. A total of 30 cranial nerve palsies were identified: 14 (47%) were permanent and 16 (53%) were temporary. The breakdown by cranial nerve was as follows: olfac- tory (cranial nerve I), one (perma- nent); ophthalmic (11), five (four per- manent); oculomotor (111), three (one permanent); trochlear (IV), two (nei- ther permanent); abducens (VI), seven (one permanent); facial (VII), seven (four permanent); and auditory (VIII), five (three permanent). No reported deficits involved the trigem- inal nerve (V) or the basal cranial nerves (IX through XII). Of all 73 patients with basilar skull fractures, four were treated with steroids. Three of the four had cranial nerve deficits, none of which resolved. One of the four steroid-treated patients was the only patient in the study to develop meningitis. Of the 73 study patients, 11 had cerebral spinal fluid leaks persisting for more than 24 hours. All 11 were treated with head elevation, and all leaks sealed spon- taneously within 11 days. Three were treated with prophylactic antibiotics, and none developed meningitis. The authors speak out against the use of both steroids and prophylactic antibiotics in the treat- ment of basilar skull fractures, regardless of the presence of a cra- nial nerve deficit or a cerebral spinal fluid leak. [Editor's note: Compared with adults with basilar skull frac- tures, the pediatric population in this study seemed to have a high inci-

dence of cranial nerve deficits. The current practice of most consulting neurosurgeons is not to treat with prophylactic antibiotics or steroids. It is also unusual that there were no reported fatalities in this series.]

Michael Kohn, MD

trauma, penetrating;

pneumatic antishock garment

The role of the pneumatic antishock garment in penetrating cardiac wounds Honigman B, Lowenstein SR, Moore E, et al

JAMA 266:2398-2401 Nov 1991

The prehospitalization treatment records of patients with penetrating cardiac wounds transported to a Level I trauma center from January 1980 through June 1987 were reviewed. Data analyzed were scene time, patient demographics, initial vital signs, mechanism of injury, and prehospital procedures performed (IV lines, volume of fluid infused, endo- tracheal intubation, and application of the pneumatic antishock garment). Penetrating cardiac wounds were identified in 70 patients. The aver- age age was 35 years, and 96% were men. Thirty-one patients (46%) had cardiac tamponade confirmed by thoracotomy. Twenty-one (30%) of patients survived--19 (49%) with stab wounds, and two (6.5%) with gunshot wounds. In a univariate analysis, only intubation and use of a pneumatic antishock garment were significantly associated with out- come, both being associated with a lower survival. Fifty patients were endotracheaily intubated, eight (16%) survived; 44 patients received a pneumatic antishock garment, eight (18%) survived. When the independent influence of the pneu- matic antishock garment was evalu- ated using a regression logistic model to control for demographic, anatomic, physical, and treatment variables, use of the pneumatic

antishock garment still had a nega- tive impact on survival. It was con- cluded that survival in patients with penetrating cardiac wounds corre- lates highly with anatomic and phys- iologic factors and that the applica- tion of the pneumatic antishock garment appears to be detrimental. [Editor's note: The results of this study indicate that the use of the pneumatic antishock garment in patients with penetrating cardiac wounds in an urban setting with short transport times appears to be detrimental. Continued critical evalu- ation of the pneumatic antishock garment is necessary to define the rational medical indications and contraindications to its use.ill

Juliana Karp, MD

1 4 4 / 4 4 8 ANNALS OF EMERGENCY MEDICINE 21:4 APRIL1992