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Antibiotics in compound depressed skull fractures
  1. Baha Ali, Senior Clinical Fellow,
  2. Angaj Ghosh, Senior Clinical Fellow,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether antibiotics reduce the incidence of meningitis in patients with compound depressed skull fracture. Altogether 198 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Baha Ali, Senior Clinical FellowChecked by Angaj Ghosh, Senior Clinical Fellow

    Clinical scenario

    A 23 year old man attends the emergency department having been assaulted outside a nightclub with a hammer. He has sustained an isolated head injury with no loss of consciousness and is fully alert and oriented. He has a compound depressed left parietal skull fracture (confirm and defined by CT scan). No surgical intervention is considered. You wonder whether the administration of antibiotics will reduce the chance of meningitis developing.

    Three part question

    In [an adult with compound depressed skull fracture] does [the administration of antibiotics] reduce [the incidence of meningitis]?

    Search strategy

    Medline 1996–07/02 using the OVID interface. [{exp skull fractures OR skull fracture$.mp} OR {(exp fractures, open OR compound fracture$.mp OR depressed fracture$.mp) AND (exp skull OR skull$.mp OR cranium$.mp OR calvarium$.mp)} AND {exp antibiotics OR antibiotic$.mp OR exp penicillin OR penicillin$.mp OR benzylpenicillin.mp OR exp metronidazole OR metronidazole.mp OR flagyl.mp}] LIMIT to human AND English language.

    Search outcome

    Altogether 198 papers were found, 197 of which were irrelevant or of insufficient quality. The remaining paper is shown in table 3.

    Table 3

    Comment(s)

    The incidence of infectious complications other than meningitis in the non-antibiotic group was higher than in the group given antibiotics.

    ▸ CLINICAL BOTTOM LINE

    The results of this study do not provide a definitive answer regarding the role of antibiotics in preventing meningitis. There is very little evidence about giving antibiotic in depressed compound skull fracture. Local advice should be followed.

    Report by Baha Ali, Senior Clinical FellowChecked by Angaj Ghosh, Senior Clinical Fellow

    References

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