Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Collaborative for Research on Acute Neurological Injuries, University of Cincinnati, Cincinnati, Ohio, USA.
J Neurotrauma. 2021 Apr 1;38(7):903-910. doi: 10.1089/neu.2020.7192. Epub 2020 Dec 14.
Acute subdural hematomas (ASDHs) are highly morbid and increasingly common. Hematoma expansion is a potentially fatal complication, and few studies have examined whether factors associated with hematoma expansion vary over time. To answer this, we performed a case-control study in a cohort of initially conservatively managed patients with ASDH. Two time periods were considered, early (<72 h from injury) and delayed (>72 h from injury). Cases were defined as patients who developed ASDH expansion in the appropriate period; controls were patients who had stable imaging. Associated factors were determined with logistic regression. We identified 68 cases and 237 controls in the early follow-up cohort. Early ASDH expansion was associated with coagulopathy (adjusted odds ratio [aOR] 2.3, 95 % CI: 1.2-4.5; 0.02), thicker ASDHs (aOR 1.1, 95% CI: 1.03-1.2; 0.006), additional intracranial lesions (aOR 3, 95% CI: 1.6-6.2; 0.002), no/minimal trauma history (aOR 0.4, 95% CI: 0.2-0.9; 0.03), and duration between injury and initial scan (aOR 0.9, 95% CI: 0.8-0.97; 0.04). In the delayed follow-up cohort, there were 41 cases and 126 controls. Delayed ASDH expansion was associated with older age (aOR 1.3 per 10 years, 95% CI: 1.1-1.6; 0.01), systolic blood pressure (SBP) >160 on hospital presentation (aOR 4.5, 95% CI: 1.8-11.3; 0.001), midline shift (aOR 1.5 per 1 mm, 95% CI: 1.3-1.9; 0.001), and convexity location (aOR 14.1, 95% CI: 2.6-265; 0.013). We conclude that early and delayed ASDH expansion are different processes with different associated factors, and that elevated SBP may be a modifiable risk factor of delayed expansion.
急性硬脑膜下血肿（ASDH）是一种高度病态且日益常见的疾病。血肿扩大是一种潜在的致命并发症，很少有研究探讨与血肿扩大相关的因素是否随时间而变化。为了解决这个问题，我们在一组最初采用保守治疗的 ASDH 患者中进行了病例对照研究。考虑了两个时间段，早期（伤后<72 小时）和延迟（伤后>72 小时）。病例定义为在适当时期发生 ASDH 扩大的患者；对照组为影像学稳定的患者。使用逻辑回归确定相关因素。我们在早期随访队列中确定了 68 例病例和 237 例对照。早期 ASDH 扩大与凝血障碍（调整后的优势比 [aOR] 2.3，95%CI：1.2-4.5；0.02）、更厚的 ASDH（aOR 1.1，95%CI：1.03-1.2；0.006）、颅内其他病变（aOR 3，95%CI：1.6-6.2；0.002）、无/轻微创伤史（aOR 0.4，95%CI：0.2-0.9；0.03）和损伤与初次扫描之间的时间（aOR 0.9，95%CI：0.8-0.97；0.04）有关。在延迟随访队列中，有 41 例病例和 126 例对照。延迟性 ASDH 扩大与年龄较大（每增加 10 岁，aOR 1.3，95%CI：1.1-1.6；0.01）、入院时收缩压（SBP）>160mmHg（aOR 4.5，95%CI：1.8-11.3；0.001）、中线移位（aOR 1.5 每 1mm，95%CI：1.3-1.9；0.001）和凸面位置（aOR 14.1，95%CI：2.6-265；0.013）有关。我们得出结论，早期和延迟性 ASDH 扩大是不同的过程，具有不同的相关因素，而升高的 SBP 可能是延迟性扩大的可改变危险因素。
