Phelan Herb A, Richter Adam A, Scott William W, Pruitt Jeffrey H, Madden Christopher J, Rickert Kim L, Wolf Steven E
1 Division of Burns/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center , Parkland Memorial Hospital, Dallas, Texas.
J Neurotrauma. 2014 Oct 15;31(20):1733-6. doi: 10.1089/neu.2014.3377. Epub 2014 Aug 27.
Evidence is emerging that isolated traumatic subarachnoid hemorrhage (ITSAH) may be a milder form of traumatic brain injury (TBI). If true, ITSAH may not benefit from intensive care unit (ICU) admission, which would, in turn, decrease resource utilization. We conducted a retrospective review of all TBI admissions to our institution between February 2010 and November 2012 to compare the presentation and clinical course of subjects with ITSAH to all other TBI. We then performed descriptive statistics on the subset of ITSAH subjects presenting with a Glasgow Coma Score (GCS) of 13-15. Of 698 subjects, 102 had ITSAH and 596 had any other intracranial hemorrhage pattern. Compared to all other TBI, ITSAH had significantly lower injury severity scores (p<0.0001), lower head abbreviated injury scores (p<0.0001), higher emergency department GCS (p<0.0001), shorter ICU stays (p=0.007), higher discharge GCS (p=0.005), lower mortality (p=0.003), and significantly fewer head computed tomography scans (p<0.0001). Of those ITSAH subjects presenting with a GCS of 13-15 (n=77), none underwent placement of an intracranial monitor or craniotomy. One subject (1.3%) demonstrated a change in exam (worsened headache and dizziness) concomitant with a progression of his intracranial injury. His symptoms resolved with readmission to the ICU and continued observation. Our results suggest that ITSAH are less-severe brain injuries than other TBI. ITSAH patients with GCS scores of 13-15 demonstrate low rates of clinical progression, and when progression occurs, it resolves without further intervention. This subset of TBI patients does not appear to benefit from ICU admission.
越来越多的证据表明，孤立性创伤性蛛网膜下腔出血（ITSAH）可能是创伤性脑损伤（TBI）的一种较轻形式。如果这一观点成立，那么ITSAH患者可能无需入住重症监护病房（ICU），进而可减少资源的利用。我们对2010年2月至2012年11月期间在我院收治的所有TBI患者进行了回顾性研究，以比较ITSAH患者与所有其他TBI患者的临床表现和临床病程。然后，我们对格拉斯哥昏迷评分（GCS）为13 - 15分的ITSAH患者亚组进行了描述性统计。在698例患者中，102例患有ITSAH，596例有其他颅内出血模式。与所有其他TBI患者相比，ITSAH患者的损伤严重程度评分显著更低（p<0.0001），头部简明损伤评分更低（p<0.0001），急诊科GCS更高（p<0.0001），ICU住院时间更短（p = 0.007），出院时GCS更高（p = 0.005），死亡率更低（p = 0.003），头部计算机断层扫描次数显著更少（p<0.0001）。在那些GCS为13 - 15分的ITSAH患者（n = 77）中，无人接受颅内监测器置入或开颅手术。1例患者（1.3%）出现了检查结果变化（头痛和头晕加重），同时伴有颅内损伤进展。再次入住ICU并持续观察后，其症状得到缓解。我们的结果表明，与其他TBI相比，ITSAH是较轻的脑损伤。GCS评分为13 - 15分的ITSAH患者临床进展发生率较低，且当进展发生时，无需进一步干预即可缓解。这一亚组的TBI患者似乎无法从入住ICU中获益。
