Original Research—Pediatric Otolaryngology Outcomes of Isolated Basilar Skull Fracture: Readmission, Meningitis, and Cerebrospinal Fluid Leak Otolaryngology– Head and Neck Surgery 149(6) 931–939 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599813508539 http://otojournal.org Brandon A. McCutcheon 1 , Ryan K. Orosco, MD 1 , David C. Chang, PhD, MPH, MBA 2 , Francesca R. Salazar 2 , Mark A. Talamini, MD 2 , Stephen Maturo, MD 3 , and Anthony Magit, MD, MPH 1 Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article. Abstract Objective. To determine rates of cerebrospinal fluid (CSF) leak, meningitis, and readmission in pediatric and adult patients with isolated basilar skull fracture. Study Design. Cross-sectional analysis of a statewide database. Subjects. Patients with isolated basilar skull fracture (1995- 2010). Methods. Patients were identified within the California Office of Statewide Health Planning and Development data- base using ICD-9 diagnosis codes. Results. A total of 3563 pediatric and 10,761 adult patients met inclusion criteria. In-hospital rates of meningitis (0.48% and 0.64%, P = .3360) and CSF leak (2.33% and 1.75%, P = .0270) were similar among children and adults, respectively. Rates of 90-day meningitis (0.17% and 0.37%, P = .0714) and CSF leak (0.40% and 0.40%, P = .9823) were also similar. Thirty-day readmission was 4.6% for children compared with 12.4% for adults (P \ .001). For both pediatric and adult patients, extra-axial hematoma (odds ratio [OR] [con- fidence interval {CI}] 1.65 [1.05-2.59] and 1.61 [1.34-1.95]) and comorbidities (OR [CI] 2.19 [1.11-4.34] and 1.28 [1.04- 1.59]) were associated with significant increases in 30-day readmission. Loss of consciousness greater than 1 hour (OR, 3.05; 95% CI, 1.53-6.08) and CSF leak (OR, 3.28; 95% CI, 1.41-7.64) increased the likelihood of pediatric readmis- sions. Lack of insurance (OR, 0.67; 95% CI, 0.50-0.90) and female gender (OR 0.83; 95% CI, 0.70-0.99) reduced the likelihood of adult readmission. Conclusion. Meningitis and CSF leak following isolated basilar skull fractures are uncommon. Readmission within 30 days was more common in adults than in children. CSF leak, hematoma, and prolonged loss of consciousness increased the likelihood of readmission in children. Intracranial injury, male gender, having insurance, and comorbidities increased the likelihood of readmission in adults. Keywords basilar skull fracture, outcomes research, 30-day readmission Received July 15, 2013; revised September 17, 2013; accepted September 20, 2013. R eadmission is an increasingly important clinical outcome associated with additional costs to health systems and psychosocial burdens to patients. Furthermore, the Centers for Medicare and Medicaid Services (CMS) have been mandated by the Affordable Care Act to penalize health institutions with higher-than- expected rates of readmission. 1 As a result, the Hospital Readmissions Reduction Program was started in October 2012 to leverage penalties against health care institutions with elevated rates of 30-day readmission. These penalties will affect nearly two-thirds of hospitals and total more than $280 million in 2013. 2 While penalties for excessive readmission have initially focused on medical conditions such as heart failure, pneu- monia, and myocardial infarction, penalties may eventually expand to admissions for traumatic injuries and other diag- noses managed by surgical teams. Unfortunately, there has been little research on the risk factors associated with these readmissions. Nor is it known whether these risk factors differ across pediatric and adult populations. 1 Division of Head and Neck Surgery, University of California San Diego, San Diego, California, USA 2 Department of Surgery, University of California San Diego, San Diego, California, USA 3 Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA This article was presented at the 2013 AAO-HNSF Annual Meeting & OTO EXPO; September 29–October 3, 2013; Vancouver, BC, Canada. Corresponding Author: Brandon A. McCutcheon, Division of Head and Neck Surgery, University of California San Diego, 4355 Rialto St #2, San Diego, CA 92107, USA. Email: bmccutch@ucsd.edu