Wang Xuanzhi, Ge Ruixiang, Yuan Jinlong, Xu Shanshui, Fang Xinggen, Dai Yi, Jiang Xiaochun
Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China.
Front Neurol. 2020 Nov 9;11:543536. doi: 10.3389/fneur.2020.543536. eCollection 2020.
Acute epidural hematoma (AEDH) is one of the deadliest lesions in patients after traumatic brain injury. AEDH with swirl sign progresses rapidly and requires timely surgical treatment. This study aims to investigate the risk factors for the occurrence of AEDH with swirl sign and its prognostic value. Retrospective analysis was performed on 131 AEDH patients, who were divided into swirl sign group and non-swirl sign group based on the brain computed tomographic (CT) scan. Patient information, including gender, age, hypertension, mechanism of injury, Glasgow Coma Scale (GCS) score on admission, time from injury to CT scan, pupillary light reactivity on admission, midline shift, location of hematoma, hematoma volume on admission, oral anticoagulation, and Glasgow Outcome Scale (GOS) score at 3 months were collected. Univariate analysis was used to determine the risk factors for the occurrence of swirl sign. The factors with < 0.05 were recruited into the multivariate logistic regression analysis and predictive receiver operating characteristic (ROC) curve model. Univariate analysis demonstrated that the GCS score on admission ( = 0.007), pupillary light reactivity ( = 0.003), location of hematoma ( < 0.0001), and GOS score at 3 months ( = 0.007) were risk factors for the occurrence of swirl sign. Multivariate logistic regression model revealed that the location of hematoma ( = 0.121; 95% CI: 0.019-0.786; = 0.027) was an independent risk factor for swirl sign, and the occurrence of swirl sign was a significant predictor of unfavorable neurological outcomes ( = 0.100; 95% CI: 0.016-0.630; = 0.014). ROC curves demonstrated that the GCS score on admission (AUC = 0.655; 95% CI: 0.506-0.804), pupillary light reactivity (AUC = 0.625; 95% CI: 0.474-0.777) and location of hematoma (AUC = 0.788; 95% CI: 0.682-0.893) can predict the occurrence of swirl sign, respectively. Remarkably, the combination of these three factors (AUC = 0.829; 95% CI: 0.753-0.906) provided a greater power to predict the swirl sign. GCS score on admission, pupillary light reactivity, and location of hematoma are risk factors for the occurrence of swirl sign, respectively. The combination of these three factors might be used to predict whether there is swirl sign in AEDH after traumatic brain injury. Furthermore, swirl sign can be used as an effective predictor of poor prognosis in patients.
急性硬膜外血肿（AEDH）是创伤性脑损伤患者中最致命的损伤之一。伴有漩涡征的AEDH进展迅速，需要及时手术治疗。本研究旨在探讨伴有漩涡征的AEDH发生的危险因素及其预后价值。对131例AEDH患者进行回顾性分析，根据脑部计算机断层扫描（CT）将其分为漩涡征组和无漩涡征组。收集患者信息，包括性别、年龄、高血压、损伤机制、入院时格拉斯哥昏迷量表（GCS）评分、受伤至CT扫描的时间、入院时瞳孔光反应、中线移位、血肿位置、入院时血肿体积、口服抗凝药以及3个月时格拉斯哥预后量表（GOS）评分。采用单因素分析确定漩涡征发生的危险因素。将P<0.05的因素纳入多因素逻辑回归分析和预测性受试者工作特征（ROC）曲线模型。单因素分析表明，入院时GCS评分（P=0.007）、瞳孔光反应（P=0.003）、血肿位置（P<0.0001）和3个月时GOS评分（P=0.007）是漩涡征发生的危险因素。多因素逻辑回归模型显示，血肿位置（P=0.121；95%CI：0.019-0.786；P=0.027）是漩涡征的独立危险因素，漩涡征的出现是不良神经结局的重要预测指标（P=0.100；95%CI：0.016-0.630；P=0.014）。ROC曲线表明，入院时GCS评分（AUC=0.655；95%CI：0.506-0.804）、瞳孔光反应（AUC=0.625；95%CI：0.474-0.777）和血肿位置（AUC=0.788；95%CI：0.
