Gupta Saksham, Iv Vycheth, Sam Nang, Vuthy Din, Klaric Katherine, Shrime Mark G, Park Kee B
Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.
World Neurosurg. 2017 Apr;100:267-270. doi: 10.1016/j.wneu.2016.12.104. Epub 2016 Dec 31.
Traumatic brain injury is a major cause of morbidity and mortality worldwide, often necessitating neurosurgical intervention to evacuate intracranial bleeding. Since the early 2000s, Cambodia has been undergoing a rapid increase in motorcycle transit and in road traffic accidents, but the prevalence of helmet usage remains low. Epidural hematomas are severe traumatic brain injuries that can necessitate neurosurgical intervention.
This is a retrospective cohort study of patients with epidural hematoma secondary to motorcycle accidents who presented to a major national tertiary care center in Phnom Penh, Cambodia, between November 2013 and March 2016. All patients were diagnosed with computed tomography of the head.
In this cohort, 21.6% of patients in motorcycle accidents presented with epidural hematoma and 89.1% of patients were men, 47.6% were intoxicated, and were 87.8% were not wearing helmets at the moment of impact. Not wearing a helmet was associated with a 6.90-fold increase in odds of presenting with a moderate-to-severe Glasgow coma scale score and a 3.76-fold increase in odds of requiring craniotomy or craniectomy for evacuation of hematoma. Male sex was also associated with increased odds of higher clinical severity at presentation and indication for craniotomy or craniectomy, and alcohol intoxication at the time of accident was not associated with either.
Helmet usage is protective in reducing the severity of presentation and need for neurosurgical intervention for patients with epidural hematoma secondary to motorcycle accidents.
创伤性脑损伤是全球发病和死亡的主要原因，常常需要进行神经外科干预以清除颅内出血。自21世纪初以来，柬埔寨的摩托车交通量和道路交通事故迅速增加，但头盔使用率仍然很低。硬膜外血肿是严重的创伤性脑损伤，可能需要进行神经外科干预。
这是一项回顾性队列研究，研究对象为2013年11月至2016年3月期间在柬埔寨金边一家主要的国家三级护理中心就诊的因摩托车事故继发硬膜外血肿的患者。所有患者均接受了头部计算机断层扫描诊断。
在该队列中，摩托车事故患者中有21.6%出现硬膜外血肿，89.1%为男性，47.6%有醉酒情况，87.8%在撞击时未戴头盔。未戴头盔与出现中度至重度格拉斯哥昏迷量表评分的几率增加6.90倍以及因清除血肿而需要开颅手术或颅骨切除术的几率增加3.76倍相关。男性在就诊时临床严重程度较高以及开颅手术或颅骨切除术指征的几率也增加，而事故发生时的酒精中毒与两者均无关。
对于因摩托车事故继发硬膜外血肿的患者，使用头盔在降低发病严重程度和减少神经外科干预需求方面具有保护作用。
