Tseng Wei-Chun, Shih Hong-Mo, Su Yi-Chun, Chen Hong-Wen, Hsiao Kuang-Yu, Chen I-Chuan
Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan.
J Trauma. 2011 Dec;71(6):1611-4; discussion 1614. doi: 10.1097/TA.0b013e31823a8a60.
In traumatic brain injury (TBI), computed tomography (CT) provides a good assessment of anatomic pathologic findings and the prognostic value of CT characteristics has been well discussed. However, few studies have focused on skull bone fracture and its clinical prognostic importance. Hence, this study aims to evaluate the effects of skull bone fracture on patients with severe TBI admitted to the emergency unit.
We reviewed the medical records of patients with isolated severe TBI admitted to the emergency unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on the presence of skull bone fracture identified by the CT scan while in the emergency unit. Mann-Whitney U test and a Student's t test were used to identify the differences between the two groups, whereas logistic regression was applied to determine any significant differences found in the statistical analysis.
A total of 197 patients were signed up in our study. Based on the presence of skull bone fracture on CT scan at emergency department, 92 patients (46.7%) comprised the skull bone fracture group and 59 patients (64.1%) of these died. One hundred five patients (53.3%) comprised the nonskull bone fracture group, of which 33 patients (31.4%) died. There is significant difference between the two groups (p = 0.004).
This study shows that skull bone fracture is a mortality risk factor for patients with isolated severe blunt TBI.
在创伤性脑损伤（TBI）中，计算机断层扫描（CT）能很好地评估解剖病理学发现，且CT特征的预后价值已得到充分讨论。然而，很少有研究关注颅骨骨折及其临床预后重要性。因此，本研究旨在评估颅骨骨折对入住急诊科的重度TBI患者的影响。
我们回顾了2003年7月至2008年6月入住某大学医院急诊科的单纯重度TBI患者的病历。根据急诊科CT扫描确定的颅骨骨折情况将患者分为两组。采用曼-惠特尼U检验和学生t检验来确定两组之间的差异，而逻辑回归用于确定统计分析中发现的任何显著差异。
共有197名患者纳入我们的研究。根据急诊科CT扫描显示的颅骨骨折情况，92名患者（46.7%）组成颅骨骨折组，其中59名患者（64.1%）死亡。105名患者（53.3%）组成非颅骨骨折组，其中33名患者（31.4%）死亡。两组之间存在显著差异（p = 0.004）。
本研究表明，颅骨骨折是单纯重度钝性TBI患者的死亡风险因素。
