Charry José D, Rubiano Andrés M, Nikas Christine V, Ortíz Juan C, Puyana Juan C, Carney Nancy, Adelson P David
Department of Basic and Clinical Sciences, Neuroscience and Neurosurgery, South Colombian University and University Hospital, Neiva, Colombia; Neurotrauma Research Group, MEDITECH Foundation, Neiva, Colombia.
Department of Surgery, University of Pittsburgh, Pittsburgh (PA), USA.
J Neurosci Rural Pract. 2016 Jan-Mar;7(1):7-12. doi: 10.4103/0976-3147.172151.
Severe traumatic brain injury (sTBI) is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD) as the main procedure for damage control (DC) therapy, performed in a University Hospital in Colombia over a 4-year period.
A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS) at 12 months postinjury. This was used to generate a dichotomous variable with "favorable" (GOS of 4 or 5) or "unfavorable" (GOS of 1-3) outcomes; analysis of variance was performed with the Chi-square, Wilcoxon-Mann-Whitney and Fisher tests.
An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4-5) was found in 70 patients (66.1%), Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score >16, obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department.
Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS.
重型创伤性脑损伤（sTBI）在拉丁美洲，尤其是在哥伦比亚，是一种导致大量死亡和残疾的疾病。本研究的目的是评估在哥伦比亚一家大学医院进行的为期4年的以早期颅骨减压术（ECD）作为损伤控制（DC）治疗的主要手段的sTBI患者的12个月临床结局。
分析了106例接受ECD手术并按照神经创伤DC策略进行管理的患者的数据库。对变量进行评估，并根据受伤后12个月的格拉斯哥预后评分（GOS）确定患者的结局。这用于生成一个二分变量，其结局为“良好”（GOS为4或5）或“不良”（GOS为1 - 3）；采用卡方检验、Wilcoxon - Mann - Whitney检验和Fisher检验进行方差分析。
该手术的总体生存率为74.6%。术后12个月时，70例患者（66.1%）获得了良好的临床结局（GOS 4 - 5）。患者的不良结局与以下因素相关：闭合性创伤、损伤严重程度评分>16、基底池闭塞、入院计算机断层扫描显示硬膜下血肿为主要损伤以及急诊科观察到瞳孔无反应。
在哥伦比亚一家资源有限的神经监测大学医院中，采用ECD治疗的sTBI患者12个月的结局显示出重要的生存率以及以GOS衡量的良好临床结局。
