D'Agostino Erin, Hong Jennifer, Sudoko Chad, Simmons Nathan, Lollis Stuart Scott
Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, Lebanon, New Hampshire, USA.
World Neurosurg. 2018 Dec;120:e274-e281. doi: 10.1016/j.wneu.2018.08.050. Epub 2018 Aug 22.
Helicopter transport may shorten transportation times for emergent neurosurgical intervention. The usefulness of helicopter transport after spontaneous intraparenchymal hemorrhage is not well studied. This study seeks to clarify factors that are associated with urgent surgical intervention in patients with spontaneous intracerebral hemorrhage following helicopter transport.
Records were reviewed for patients with spontaneous intraparenchymal hemorrhage transported by helicopter to Dartmouth-Hitchcock Medical Center between January 2008 and December 2011. Records were evaluated for factors associated with emergent tertiary-level care intervention during the first 24 hours of admission.
A total of 107 patients met inclusion criteria, with a mean age of 67.2 years. At presentation, 79 (75.24%) were hypertensive, 22 (21.57%) had an increased international normalized ratio, and 47 (45.19%) were intubated. Thirty-three patients (30.8%) underwent 1 or more neurosurgical interventions within 24 hours of arrival, with an additional 6 (5.6%) patients undergoing neurosurgical intervention after 24 hours after admission. On univariate analysis, age, Glasgow Coma Scale (GCS) score, and clot volume were significant predictors of neurosurgical intervention within 24 hours of interfacility helicopter transport. A lobar clot, presence of intraventricular hemorrhage, and presence of >1 cm of midline shift were also associated with neurosurgical intervention within 24 hours. On multivariate analysis, younger age, GCS score of 3-8, and lobar hemorrhage were independent predictors of neurosurgical intervention within 24 hours.
Two thirds of patients did not undergo any surgical intervention during the first 24 hours of admission after interfacility helicopter transfer. Factors associated with urgent neurosurgical intervention included younger age, low GCS score, and presence of lobar hemorrhage.
直升机转运可能会缩短紧急神经外科手术干预的运输时间。自发性脑实质内出血后直升机转运的实用性尚未得到充分研究。本研究旨在阐明与直升机转运后自发性脑出血患者紧急手术干预相关的因素。
回顾2008年1月至2011年12月期间通过直升机转运至达特茅斯-希区柯克医疗中心的自发性脑实质内出血患者的记录。对入院后最初24小时内与紧急三级护理干预相关的因素进行评估。
共有107例患者符合纳入标准，平均年龄为67.2岁。就诊时，79例（75.24%）患有高血压，22例（21.57%）国际标准化比值升高，47例（45.19%）已插管。33例患者（30.8%）在到达后24小时内接受了1次或更多次神经外科手术干预，另有6例（5.6%）患者在入院24小时后接受了神经外科手术干预。单因素分析显示，年龄、格拉斯哥昏迷量表（GCS）评分和血凝块体积是机构间直升机转运后24小时内神经外科手术干预的重要预测因素。脑叶血凝块、脑室内出血的存在以及中线移位>1 cm也与24小时内的神经外科手术干预有关。多因素分析显示，年龄较小、GCS评分为3 - 8分以及脑叶出血是24小时内神经外科手术干预的独立预测因素。
在机构间直升机转运后入院的最初24小时内，三分之二的患者未接受任何手术干预。与紧急神经外科手术干预相关的因素包括年龄较小、GCS评分较低以及脑叶出血。
