Hochstadter Elana, Stewart Tanya Charyk, Alharfi Ibrahim M, Ranger Adrianna, Fraser Douglas D
Department of Pediatrics, Western University, London, ON, Canada.
Neurocrit Care. 2014 Dec;21(3):505-13. doi: 10.1007/s12028-014-9986-7.
Subarachnoid hemorrhage (SAH) is an independent prognostic indicator of outcome in adult severe traumatic brain injury (sTBI). There is a paucity of investigations on SAH in pediatric sTBI. The goal of this study was to determine in pediatric sTBI patients SAH prevalence, associated factors, and its relationship to short-term outcome.
We retrospectively analyzed 171 sTBI patients (pre-sedation GCS ≤8 and head MAIS ≥4) who underwent CT head imaging within the first 24 h of hospital admission. Data were analyzed with both univariate and multivariate techniques.
SAH was found in 42 % of sTBI patients (n = 71/171), and it was more frequently associated with skull fractures, cerebral edema, diffuse axonal injury, contusion, and intraventricular hemorrhage (p < 0.05). Patients with SAH had higher Injury Severity Scores (p = 0.032) and a greater frequency of fixed pupil(s) on admission (p = 0.001). There were no significant differences in etiologies between sTBI patients with and without SAH. Worse disposition occurred in sTBI patients with SAH, including increased mortality (p = 0.009), increased episodes of central diabetes insipidus (p = 0.002), greater infection rates (p = 0.002), and fewer ventilator-free days (p = 0.001). In sTBI survivors, SAH was associated with increased lengths of stay (p < 0.001) and a higher level of care required on discharge (p = 0.004). Despite evidence that SAH is linked to poorer outcomes on univariate analyses, multivariate analysis failed to demonstrate an independent association between SAH and mortality (p = 0.969).
SAH was present in almost half of pediatric sTBI patients, and it was indicative of TBI severity and a higher level of care on discharge. SAH in pediatric patients was not independently associated with increased risk of mortality.
蛛网膜下腔出血（SAH）是成人重型创伤性脑损伤（sTBI）预后的独立预测指标。关于小儿sTBI中SAH的研究较少。本研究的目的是确定小儿sTBI患者中SAH的患病率、相关因素及其与短期预后的关系。
我们回顾性分析了171例在入院后24小时内接受头颅CT成像的sTBI患者（镇静前格拉斯哥昏迷量表评分≤8分且头部简明损伤定级标准评分≥4分）。采用单因素和多因素技术对数据进行分析。
42%的sTBI患者（n = 71/171）发现有SAH，且其更常与颅骨骨折、脑水肿、弥漫性轴索损伤、挫伤和脑室内出血相关（p < 0.05）。SAH患者的损伤严重程度评分更高（p = 0.032），入院时固定瞳孔的发生率更高（p = 0.001）。有SAH和无SAH的sTBI患者在病因方面无显著差异。SAH的sTBI患者预后更差，包括死亡率增加（p = 0.009）、中枢性尿崩症发作次数增加（p = 0.002）、感染率更高（p = 0.002）以及无呼吸机天数减少（p = 0.001）。在sTBI幸存者中，SAH与住院时间延长（p < 0.001）和出院时所需护理级别更高（p = 0.004）相关。尽管单因素分析有证据表明SAH与较差的预后相关，但多因素分析未能证明SAH与死亡率之间存在独立关联（p = 0.969）。
几乎一半的小儿sTBI患者存在SAH，这表明TBI的严重程度以及出院时更高的护理级别。小儿患者的SAH与死亡率增加无独立关联。
