Shibahashi Keita, Sugiyama Kazuhiro, Okura Yoshihiro, Hoda Hidenori, Hamabe Yuichi
Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
World Neurosurg. 2018 Jun;114:e350-e355. doi: 10.1016/j.wneu.2018.02.183. Epub 2018 Mar 9.
Data on traumatic intraventricular hemorrhage (IVH) are currently limited, and therefore, the condition is not fully understood. The aim of this study was to determine the epidemiology of traumatic IVH and its effects on outcome in patients with blunt head trauma.
Using a nationwide trauma registry-the Japan Trauma Data Bank, we identified patients who underwent head computed tomography (CT) after blunt head trauma and had intracranial injuries between 2004 and 2015. The endpoint was in-hospital mortality. We compared patients with IVH and without IVH and adjusted for potential confounders using a multivariate logistic regression model.
A total of 236,698 patients were registered in the database. Of the 139,058 patients who underwent head CT after blunt trauma, 906 (0.7%) had traumatic IVH. Among the 53,618 patients who were eligible for analysis, 871 had IVH. Traumatic IVH was associated with the occurrence of traffic accidents that caused trauma and severe injuries. Mortality was significantly higher in patients with IVH than in those without IVH (33.5% vs. 18.5%; P < 0.001); however, the difference was not significant after adjusting for confounding factors, with an adjusted odds ratio of 1.13 (95% confidence interval: 0.91-1.40).
Traumatic IVH is associated with a high mortality. However, the outcome in patients with traumatic IVH was worse than that in patients without IVH, which could be a result of factors associated with IVH rather than of IVH alone.
目前关于创伤性脑室内出血(IVH)的数据有限,因此,这种情况尚未得到充分了解。本研究的目的是确定创伤性IVH的流行病学及其对钝性头部创伤患者预后的影响。
我们使用全国性创伤登记处——日本创伤数据库,确定了2004年至2015年间钝性头部创伤后接受头部计算机断层扫描(CT)且有颅内损伤的患者。终点是住院死亡率。我们比较了有IVH和无IVH的患者,并使用多变量逻辑回归模型对潜在混杂因素进行了调整。
数据库中共登记了236,698例患者。在139,058例钝性创伤后接受头部CT检查的患者中,906例(0.7%)有创伤性IVH。在53,618例符合分析条件的患者中,871例有IVH。创伤性IVH与导致创伤和重伤的交通事故发生有关。有IVH的患者死亡率显著高于无IVH的患者(33.5%对18.5%;P<0.001);然而,在调整混杂因素后差异不显著,调整后的优势比为1.13(95%置信区间:0.91-1.40)。
创伤性IVH与高死亡率相关。然而,创伤性IVH患者的预后比无IVH患者更差,这可能是与IVH相关的因素而非单纯IVH导致的结果。