Schwed Alexander C, Boggs Monica M, Watanabe Drew, Plurad David S, Putnam Brant A, Kim Dennis Y
Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
Am Surg. 2016 Oct;82(10):898-902.
Consensus is lacking for ideal management of mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH). Patients are often monitored in the intensive care unit (ICU) without additional interventions. We sought to identify admission variables associated with a favorable outcome (ICU admission for 24 hours, no neurosurgical interventions, no complications or mortality) to divert these patients to a non-ICU setting in the future. We reviewed all patients with mTBI [Glasgow Coma Scale (GCS) = 13-15] and concomitant ICH between July 1, 2012, and June 30, 2015. Variables collected included demographics, vital signs, neurologic examination, imaging results, ICU course, mortality, and disposition. Of 201 patients, 78 (39%) had a favorable outcome. On univariate analysis, these patients were younger, more often had an isolated subarachnoid hemorrhage, and were more likely to have a GCS of 15 at admission. On multivariate regression analysis, after controlling for admission blood pressure, time to CT scan, and Marshall Score, age <55, GCS of 15 on arrival to the ICU, and isolated subarachnoid hemorrhage remained independent predictors of a favorable outcome. Patients meeting these criteria after mTBI with ICH likely do not require ICU-level care.
对于伴有颅内出血(ICH)的轻度创伤性脑损伤(mTBI)的理想管理,目前缺乏共识。患者通常在重症监护病房(ICU)接受监测,无需额外干预。我们试图确定与良好预后(在ICU住院24小时、无需神经外科干预、无并发症或死亡)相关的入院变量,以便将来将这些患者转到非ICU环境。我们回顾了2012年7月1日至2015年6月30日期间所有患有mTBI[格拉斯哥昏迷量表(GCS)=13 - 15]并伴有ICH的患者。收集的变量包括人口统计学、生命体征、神经系统检查、影像学结果、ICU病程、死亡率和处置情况。在201例患者中,78例(39%)预后良好。单因素分析显示,这些患者年龄较小,更常出现单纯蛛网膜下腔出血,且入院时GCS更可能为15分。多因素回归分析显示,在控制入院血压、CT扫描时间和马歇尔评分后,年龄<55岁、入住ICU时GCS为15分以及单纯蛛网膜下腔出血仍然是良好预后的独立预测因素。mTBI合并ICH后符合这些标准的患者可能不需要ICU级别的护理。