Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
World Neurosurg. 2014 Nov;82(5):e639-44. doi: 10.1016/j.wneu.2014.06.022. Epub 2014 Jun 17.
Traumatic brain injury (TBI) is a common cause of morbidity and mortality worldwide. It is difficult to estimate the real incidence of traumatic subarachnoid hemorrhage (TSAH). Although TSAH after trauma is associated with poor prognoses, the impact of mechanism of injury (MOI) and the pathophysiology remains unknown. We hypothesized that outcome of TSAH caused by motor vehicle crash (MVC) or fall from height (FFH) varies based on the MOI.
Data were collected retrospectively from a prospectively created database registry in the section of Trauma Surgery at Hamad General Hospital between January 2008 and July 2012. All patients presented with head trauma and TSAH were included. Patient data included age, gender, nationality, mechanism of injury, injury severity score (ISS), types of head injuries, and associated injuries. Ventilator days, intensive care unit length of stay, pneumonia, and mortality were also studied.
A total of 1665 patients with TBI were identified, of them 403 had TSAH with a mean age of 35 ± 15 years. Of them 93% were male patients and 86% were expatriates. MVC (53%) and FFH (35%) were the major mechanisms of injury. The overall mean ISS and head abbreviated injury score were 19 ± 10.6 and 3.4 ± 0.96, respectively. Patients in MVC group sustained severe TSAH, had significantly greater head abbreviated injury score (3.5 ± 0.9 vs. 3.2 ± 0.9; P = 0.009) and ISS (21.6 ± 10.6 vs. 15.9 ± 9.5; P = 0.001), and lower scene Glasgow coma scale (10.8 ± 4.8 vs. 13.2 ± 3.4; P = 0.001) compared with the FFH group. In addition, the MVC group sustained more intraventricular hemorrhage (4.7 vs. 0.7; P = 0.001) and diffuse axonal injury (4.2 vs. 2.9; P = 0.001). In contrast, extradural hemorrhage (14.3% vs. 11.6%; P = 0.008) was higher in the FFH group. Lower extremities (14% vs. 4.3%; P = 0.004) injury was mainly associated with the MVC group. The overall mortality was 19 % among patients with TSAH. The mortality rate was higher in the MVC group when compared with the FFH group (24% vs. 10%; P = 0.001). In both groups, ISS and Glasgow coma scale at the scene were independent predictors of mortality.
Patients with TSAH have a higher mortality rate. In this population, MVCs are associated with a 3-fold increased risk of mortality. Therefore, prevention of MVC and fall can reduce the incidence and severity of TBI in Qatar.
创伤性脑损伤（TBI）是全球发病率和死亡率的常见原因。外伤性蛛网膜下腔出血（TSAH）的真实发病率很难估计。尽管创伤后 TSAH 与预后不良有关，但损伤机制（MOI）和发病机制的影响仍不清楚。我们假设机动车碰撞（MVC）或高处坠落（FFH）引起的 TSAH 的结果因 MOI 而异。
数据是从 2008 年 1 月至 2012 年 7 月在哈马德综合医院创伤外科部分创建的前瞻性数据库登记处中回顾性收集的。所有出现头部创伤和 TSAH 的患者均被纳入研究。患者数据包括年龄、性别、国籍、损伤机制、损伤严重程度评分（ISS）、头部损伤类型和相关损伤。还研究了呼吸机天数、重症监护病房住院时间、肺炎和死亡率。
共确定了 1665 例 TBI 患者，其中 403 例有 TSAH，平均年龄为 35 ± 15 岁。其中 93%为男性患者，86%为侨民。MVC（53%）和 FFH（35%）是主要的损伤机制。总体平均 ISS 和头部简明损伤评分分别为 19 ± 10.6 和 3.4 ± 0.96。MVC 组患者发生严重 TSAH，头部简明损伤评分（3.5 ± 0.9 比 3.2 ± 0.9；P = 0.009）和 ISS（21.6 ± 10.6 比 15.9 ± 9.5；P = 0.001）显著更高，且现场格拉斯哥昏迷量表评分（10.8 ± 4.8 比 13.2 ± 3.4；P = 0.001）更低与 FFH 组相比。此外，MVC 组发生更多的脑室内出血（4.7 比 0.7；P = 0.001）和弥漫性轴索损伤（4.2 比 2.9；P = 0.001）。相比之下，FFH 组硬膜外血肿（14.3%比 11.6%；P = 0.008）更高。下肢（14%比 4.3%；P = 0.004）损伤主要与 MVC 组有关。TSAH 患者的总体死亡率为 19%。与 FFH 组相比，MVC 组的死亡率更高（24%比 10%；P = 0.001）。在这两组中，ISS 和现场格拉斯哥昏迷量表评分是死亡率的独立预测因素。
患有 TSAH 的患者死亡率较高。在该人群中，MVC 导致死亡率增加 3 倍。因此，预防 MVC 和跌倒可以降低卡塔尔的 TBI 发生率和严重程度。
