Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
World Neurosurg. 2019 May;125:e665-e670. doi: 10.1016/j.wneu.2019.01.145. Epub 2019 Feb 2.
Fall with head injury is a pervasive challenge, especially in the aging population. Contributing factors for mortality include the development of cerebral contusions and delayed traumatic intracerebral hematoma. Currently, there is no established specific treatment for these conditions.
This study aimed to investigate the impact of independent factors on the mortality rate of traumatic brain injury with contusions or traumatic subarachnoid hemorrhage.
Data were collected from consecutive patients admitted for cerebral contusions or traumatic subarachnoid hemorrhage at an academic trauma center from 2010 to 2016. The primary outcome was the 30-day mortality rate. Independent factors for analysis included patient factors and treatment modalities. Univariate and multivariate analyses were conducted to identify independent factors related to mortality. Secondary outcomes included thromboembolic complication rates associated with the use of tranexamic acid.
In total, 651 consecutive patients were identified. For the patient factors, low Glasgow Coma Scale on admission, history of renal impairment, and use of warfarin were identified as independent factors associated with higher mortality from univariate and multivariate analyses. For the treatment modalities, univariate analysis identified tranexamic acid as an independent factor associated with lower mortality (P = 0.021). Thromboembolic events were comparable in patients with or without tranexamic acid.
Tranexamic acid was identified by univariate analysis as an independent factor associated with lower mortality in cerebral contusions or traumatic subarachnoid hemorrhage. Further prospective studies are needed to validate this finding.
头部受伤导致的跌倒在老龄化人群中普遍存在，是一个严重的问题。导致死亡率的因素包括脑挫裂伤和外伤性迟发性脑内血肿的发展。目前，对于这些情况还没有确立的特定治疗方法。
本研究旨在探讨独立因素对创伤性脑损伤伴脑挫裂伤或外伤性蛛网膜下腔出血患者死亡率的影响。
本研究连续收集了 2010 年至 2016 年在学术创伤中心因脑挫裂伤或外伤性蛛网膜下腔出血入院的患者数据。主要结局是 30 天死亡率。分析的独立因素包括患者因素和治疗方式。进行单因素和多因素分析以确定与死亡率相关的独立因素。次要结局包括使用氨甲环酸相关的血栓栓塞并发症发生率。
共纳入 651 例连续患者。单因素和多因素分析均表明，入院时格拉斯哥昏迷量表评分低、肾功能不全史和使用华法林是与死亡率升高相关的独立因素。在治疗方式方面，单因素分析确定氨甲环酸是与死亡率降低相关的独立因素（P=0.021）。使用氨甲环酸与不使用氨甲环酸的患者血栓栓塞事件发生率相当。
氨甲环酸通过单因素分析被确定为与脑挫裂伤或外伤性蛛网膜下腔出血患者死亡率降低相关的独立因素。需要进一步的前瞻性研究来验证这一发现。
