Fujii Tatsuhiro, Moriel Gabriela, Kramer Daniel R, Attenello Frank, Zada Gabriel
Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089-0894, USA.
Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089-0894, USA.
J Clin Neurosci. 2016 Sep;31:152-6. doi: 10.1016/j.jocn.2016.03.007. Epub 2016 Jul 14.
Over the past several decades, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has steadily increased, yet mortality in these patients has decreased. This improvement in outcome is largely due to advances in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. It is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment. Equally important is the identification of patients with good prognostic signs among patients receiving surgical intervention for TBI. We conducted a retrospective chart review of 181 patients requiring craniectomies and craniotomies for decompression or evacuation of an intracranial hemorrhage following TBI at a single level I trauma center between 2008-2010. Demographic features and perioperative clinical characteristics of these patients were examined in relation to favorable outcomes, defined as discharge to home or a rehabilitation facility, and unfavorable outcomes, defined as in-hospital mortality or discharge to step-down medical facilities. Younger age, greater Glasgow Coma Scale (GCS) score on admission, absence of preoperative coagulopathies, absence of hypernatremia, and absence of fever were all independent predictors of favorable outcome. Additionally, increased operative duration and increased length of hospital stay were identified as independent predictors of negative outcomes after surgery. This work supports some of the current prognostic models in the literature and identifies additional clinical variables with predictive value of early outcome and discharge status in patients undergoing surgical evacuation of traumatic intracranial hemorrhages.
在过去几十年中，美国与创伤性脑损伤（TBI）相关的急诊室就诊率稳步上升，但这些患者的死亡率却有所下降。这种预后的改善很大程度上归功于院前护理、重症监护病房管理的进步，以及诸如减压颅骨切除术等神经外科手术的有效性。识别能够预测哪些患者能从早期资源调动和手术治疗中获益的临床因素至关重要。同样重要的是，在接受TBI手术干预的患者中识别出具有良好预后迹象的患者。我们对2008年至2010年间在一家一级创伤中心因TBI后需要进行颅骨切除术和开颅术以减压或清除颅内出血的181例患者进行了回顾性病历审查。研究了这些患者的人口统计学特征和围手术期临床特征与良好预后（定义为出院回家或转至康复机构）和不良预后（定义为住院死亡或转至降级医疗设施）的关系。年龄较小、入院时格拉斯哥昏迷量表（GCS）评分较高、术前无凝血功能障碍、无高钠血症以及无发热都是良好预后的独立预测因素。此外，手术时间延长和住院时间延长被确定为术后不良结果的独立预测因素。这项工作支持了文献中一些当前的预后模型，并识别出了其他临床变量，这些变量对接受创伤性颅内出血手术清除的患者的早期预后和出院状态具有预测价值。
