Ng Isaac, Bugaev Nikolay, Riesenburger Ron, Shpiner Aaron C, Breeze Janis L, Arabian Sandra S, Rabinovici Reuven
Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States.
Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, #4488, Boston, MA 02111, United States.
J Clin Neurosci. 2019 Feb;60:58-62. doi: 10.1016/j.jocn.2018.10.035. Epub 2018 Oct 17.
Infratentorial traumatic intracranial bleeds (ICBs) are rare and the distribution of subtypes is unknown. To characterize this distribution the National Trauma Data Bank (NTDB) 2014 was queried for adults with single type infratentorial ICB, n = 1,821: subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), and intraparenchymal hemorrhage (IPH). Comparisons were made between the groups with statistical significance determined using chi squared and t-tests. SDH occurred in 29% of patients, mostly in elderly on anti-coagulants (13%) after a fall (77%), 42% of them underwent craniotomy, their mortality was the lowest (4%). SAH was the most common (56%) occurring mostly from traffic related injuries (27%). Furthermore, 9% of them had a severe head injury Glasgow Coma Scale ≤8 (GCS), but had the lowest Injury Severity Score (ISS, median 8) as well as a short hospital length of stay, 5.1 ± 6.2 days. These patients were most likely to be discharged to home (64%). They had the lowest mortality (4%). EDH was the least common ICB (5%), occurred in younger patients (median age 49 years), and it had the highest percentage of associated injuries (13%). EDH patients presented with the poorest neurological status (26% GCS ≤8, ISS median 25) and were operated on more than any other ICB type (55%). EDH was the highest mortality (9%) ICB type and had a low discharge to home rate (58%). IPH was uncommon (10%). Infratentorial bleeds types have different clinical courses, and outcomes. Understanding these differences can be useful in managing these patients.
幕下创伤性颅内出血（ICB）较为罕见，其亚型分布尚不明确。为了明确这种分布情况，我们查询了2014年国家创伤数据库（NTDB）中患有单一类型幕下ICB的成年患者，共1821例：硬膜下出血（SDH）、蛛网膜下腔出血（SAH）、硬膜外出血（EDH）和脑实质内出血（IPH）。对各组进行了比较，并使用卡方检验和t检验确定统计学意义。SDH发生在29%的患者中，大多为使用抗凝剂的老年人（13%），跌倒后发病（77%），其中42%接受了开颅手术，其死亡率最低（4%）。SAH最为常见（56%），大多由交通相关损伤导致（27%）。此外，9%的患者格拉斯哥昏迷量表（GCS）评分≤8，属于重型颅脑损伤，但损伤严重程度评分（ISS，中位数8）最低，住院时间也较短，为5.1±6.2天。这些患者最有可能出院回家（64%）。他们的死亡率最低（4%）。EDH是最不常见的ICB类型（5%），发生在较年轻的患者中（中位年龄49岁），且合并伤的比例最高（13%）。EDH患者的神经功能状态最差（26%的GCS≤8，ISS中位数25），接受手术的比例高于其他任何ICB类型（55%）。EDH是死亡率最高（9%）的ICB类型，出院回家率较低（58%）。IPH并不常见（10%）。幕下出血类型具有不同的临床病程和预后。了解这些差异有助于对这些患者进行管理。
