Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Injury. 2012 Sep;43(9):1419-22. doi: 10.1016/j.injury.2011.03.017. Epub 2011 Apr 7.
To review the outcome of patients with post-traumatic acute subdural haematoma (ASDH) before and after the establishment of a hospital trauma team at a designated trauma centre.
A retrospective analysis was conducted on 82 consecutive patients who underwent surgery for post-traumatic ASDH. The 'PRE' and 'POST' groups included patients admitted before and after the establishment of a hospital trauma team, respectively. Injury severity was assessed by the admission Glasgow coma score, imaging findings, and the revised trauma score. Clinical outcome measures were the hospital length of stay and the Glasgow outcome score (GOS) upon hospital discharge.
The overall mortality rate was 53.7%. No significant difference was found between the PRE and POST groups. The mean length of hospital stay was also comparable between the two groups. The functional status of those who survived acute hospital care was significantly better in the POST group. Good outcome (GOS of 4 or 5) was achieved in 66.7% of the survivors in the POST group, compared with 25.0% in the PRE group (p=0.024).
Post-traumatic ASDH carried a poor prognosis. The mortality rate and hospital length of stay of patients were not found to be reduced after the establishment of a hospital trauma team. The latter, however, was associated with significantly better functional outcome amongst survivors. Although causality cannot be established due to the multitude of factors which may have affected patient outcome, our findings nonetheless provide further support for the introduction of a multidisciplinary hospital trauma team for the optimal care of trauma patients.
回顾在指定创伤中心建立医院创伤团队前后外伤性急性硬脑膜下血肿（ASDH）患者的结局。
对 82 例连续接受外伤性 ASDH 手术的患者进行回顾性分析。“PRE”和“POST”组分别包括创伤团队建立前和建立后的入院患者。损伤严重程度由入院格拉斯哥昏迷评分、影像学表现和修订创伤评分评估。临床结局测量指标为住院时间和出院时格拉斯哥预后评分（GOS）。
总体死亡率为 53.7%。PRE 组和 POST 组之间无显著差异。两组的平均住院时间也相似。存活患者在 POST 组的功能状态明显优于 PRE 组。POST 组幸存者的良好结局（GOS 为 4 或 5）为 66.7%，而 PRE 组为 25.0%（p=0.024）。
外伤性 ASDH 预后较差。建立医院创伤团队后，患者的死亡率和住院时间并未降低。然而，后者与幸存者的功能结局显著改善相关。尽管由于可能影响患者结局的众多因素，无法确定因果关系，但我们的研究结果仍为引入多学科医院创伤团队为创伤患者提供最佳治疗提供了进一步支持。
