Neurosurgery Unit, Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Tabor Sub-city, Hawassa, Ethiopia.
Neurosurgery Unit, Department of Surgery, Addis Ababa University Tikur Anbessa Specialized Hospital, Lideta Sub-city, Addis Ababa, Ethiopia.
World Neurosurg. 2022 Feb;158:e55-e63. doi: 10.1016/j.wneu.2021.10.089. Epub 2021 Oct 14.
Depressed skull fracture is one of the most common neurosurgical emergencies in Ethiopia. The clinical outcome after surgical management and what factors predict the outcome are not well studied. Our study aimed to assess the outcome and identify predictors of the outcome in surgically treated adult patients.
A prospective, multicenter, observational study was undertaken on 197 cases, at 4 selected neurosurgical teaching hospitals in Ethiopia. Relevant data were collected and analyzed using Statistical Package for the Social Sciences software (IBM, Armonk, New York, USA). The outcome was assessed by the extended Glasgow Outcome Scale. Multivariate analysis was done to identify independent predictors of the outcome.
The outcome was favorable in 81.2%. The mean age was 27. The mode of injury was violence in 79.7%. Motor deficit witnessed in 24.4%. Based on the Glasgow Coma Scale, 92.2% of patients had mild traumatic brain injury. Associated intracranial lesions were identified in 87.3%. The median hospital stay was 4.7 days. Reoperation and mortality rates were 4.1% and 0.5%, respectively. Five factors were statistically significant independent predictors of unfavorable outcome in multivariate analysis: motor deficit (adjusted odds ratio [AOR] 13.8, 95% confidence interval [CI]: 4.13-46.17, P = 0.000), Glasgow Coma Scale ≤13 (AOR 10.36, 95% CI: 1.93-55.56, P = 0.006), pneumocephalus (AOR 12.93, 95% CI: 3.12-53.52, P = 0.000), hospital stay for ≥3 days (AOR 4.39, 95% CI: 1.18-16.3, P = 0.027), and reoperation (AOR 6.92, 95% CI: 1.09-43.97, P = 0.04).
The overall outcome was favorable. The presence of motor deficit, postresuscitation Glasgow Coma Scale ≤13, pneumocephalus, reoperation, and hospital stays for ≥3 days were independent predictors of an unfavorable outcome.
凹陷性颅骨骨折是埃塞俄比亚最常见的神经外科急症之一。手术治疗后的临床结果以及哪些因素可预测结果尚未得到充分研究。我们的研究旨在评估手术治疗的成年患者的结果，并确定其结局的预测因素。
在埃塞俄比亚的 4 家选定的神经外科教学医院进行了一项前瞻性、多中心、观察性研究。使用社会科学统计软件包（IBM，纽约州阿蒙克）收集和分析相关数据。使用格拉斯哥预后量表评估结果。进行多变量分析以确定结果的独立预测因素。
结果良好的占 81.2%。平均年龄为 27 岁。79.7%的损伤模式为暴力。24.4%存在运动障碍。根据格拉斯哥昏迷量表，92.2%的患者为轻度创伤性脑损伤。87.3%的患者存在颅内合并伤。中位住院时间为 4.7 天。再手术率和死亡率分别为 4.1%和 0.5%。多变量分析中，有 5 个因素是无预后的统计学显著独立预测因素：运动障碍（调整优势比[OR] 13.8，95%置信区间[CI]：4.13-46.17，P=0.000），格拉斯哥昏迷量表评分≤13（OR 10.36，95%CI：1.93-55.56，P=0.006），气颅（OR 12.93，95%CI：3.12-53.52，P=0.000），住院时间≥3 天（OR 4.39，95%CI：1.18-16.3，P=0.027）和再手术（OR 6.92，95%CI：1.09-43.97，P=0.04）。
总体结果良好。存在运动障碍、复苏后格拉斯哥昏迷量表评分≤13、气颅、再手术和住院时间≥3 天是预后不良的独立预测因素。
