Katayama Yusuke, Kitamura Tetsuhisa, Kiyohara Kosuke, Sado Junya, Hirose Tomoya, Matsuyama Tasuku, Kiguchi Takeyuki, Tachino Jotaro, Nakao Shunichiro, Umemura Yutaka, Nakagawa Yuko, Shimazu Takeshi
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):251-259. doi: 10.1007/s00068-019-01224-z. Epub 2019 Sep 3.
Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan.
This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy.
Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]).
In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.
创伤后脑膜炎是一种严重并发症，可导致创伤患者死亡率增加和住院时间延长。脑脊液（CSF）瘘和颅底骨折等因素与创伤后脑膜炎相关。然而，急诊科的钻孔手术和减压性颅骨切除术等操作是否与创伤后脑膜炎相关仍不清楚。本研究的目的是利用日本全国基于医院的创伤登记系统评估与创伤后脑膜炎相关的因素。
这是一项回顾性观察研究，研究期为2004年1月至2015年12月，共12年。本研究纳入了日本创伤数据库中登记的创伤患者，这些患者的头部简明损伤量表评分≥3分。主要终点是住院期间脑膜炎的发生情况。多变量逻辑回归分析用于评估与创伤后脑膜炎相关的独立参数，如脑脊液瘘、急诊科的钻孔手术和减压性颅骨切除术。
在60390例头部AIS评分3分或以上的头部受伤患者中，284例（0.5%）发生了创伤后脑膜炎。与创伤后脑膜炎相关的因素包括急诊科的钻孔手术（调整后的优势比[AOR]为2.158[95%置信区间（CI）1.401 - 3.325]）、减压性颅骨切除术（AOR为2.123[95%CI 1.506 - 2.993]）、脑室外引流（AOR为1.843[95%CI，1.157 - 2.935]）、脑脊液漏（AOR为3.328[95%CI 2.205 - 5.022]）和颅底骨折（AOR为1.651[95%CI 1.178 - 2.314]）。
在这群创伤患者中，急诊科的钻孔手术和减压性颅骨切除术与创伤后脑膜炎相关。
