Pastorek Rachel A, Cripps Michael W, Bernstein Ira H, Scott William W, Madden Christopher J, Rickert Kim L, Wolf Steven E, Phelan Herb A
1 Department of Surgery, UT Southwestern Medical Center , Parkland Memorial Hospital, Dallas, Texas.
J Neurotrauma. 2014 Oct 15;31(20):1737-43. doi: 10.1089/neu.2014.3366. Epub 2014 Aug 28.
As a basis for venous thromboembolism (VTE) prophylaxis after traumatic brain injury (TBI), we have previously published an algorithm known as the Parkland Protocol. Patients are classified by risk for spontaneous progression of hemorrhage with chemoprophylaxis regimens tailored to each tier. We sought to validate this schema. In our algorithm, patients with any of the following are classified "low risk" for spontaneous progression: subdural hemorrhage ≤8 mm thick; epidural hemorrhage ≤8 mm thick; contusions ≤20 mm in diameter; a single contusion per lobe; any amount of subarachnoid hemorrhage; or any amount of intraventricular hemorrhage. Patients with any injury exceeding these are "moderate risk" for progression, and any patient receiving a monitor or craniotomy is "high risk." From February 2010 to November 2012, TBI patients were entered into a dedicated database tracking injury types and sizes, risk category at presentation, and progression on subsequent computed tomgraphies (CTs). The cohort (n=414) was classified as low risk (n=200), moderate risk (n=75), or high risk (n=139) after first CT. After repeat CT scan, radiographic progression was noted in 27% of low-risk, 53% of moderate-risk, and 58% of high-risk subjects. Omnibus analysis of variance test for differences in progression rates was highly significant (p<0.0001). Tukey's post-hoc test showed the low-risk progression rate to be significantly different than both the moderate- and high-risk arms; no difference was noted between the moderate- and high-risk arms themselves. These criteria are a valid tool for classifying TBI patients into two categories of risk for spontaneous progression. This supports tailored chemoprophylaxis regimens for each arm.
作为创伤性脑损伤（TBI）后静脉血栓栓塞症（VTE）预防的基础，我们之前发表了一种名为帕克兰方案的算法。患者根据出血自发进展风险进行分类，并为每个层级量身定制化学预防方案。我们试图验证这一模式。在我们的算法中，有以下任何一种情况的患者被分类为出血自发进展“低风险”：硬膜下血肿厚度≤8毫米；硬膜外血肿厚度≤8毫米；挫伤直径≤20毫米；每叶一个挫伤；任何量的蛛网膜下腔出血；或任何量的脑室内出血。任何损伤超过这些标准的患者进展为“中度风险”，任何接受监测或开颅手术的患者为“高风险”。从2010年2月到2012年11月，TBI患者被录入一个专门的数据库，跟踪损伤类型和大小、就诊时的风险类别以及后续计算机断层扫描（CT）上的进展情况。在首次CT检查后，该队列（n = 414）被分类为低风险（n = 200）、中度风险（n = 75）或高风险（n = 139）。在重复CT扫描后，低风险组中有27%、中度风险组中有53%、高风险组中有58%的受试者出现影像学进展。对进展率差异进行的方差分析检验具有高度显著性（p < 0.0001）。Tukey事后检验显示，低风险进展率与中度和高风险组均有显著差异；中度和高风险组之间未发现差异。这些标准是将TBI患者分类为出血自发进展两类风险的有效工具。这支持为每个组量身定制化学预防方案。
