Nożewski Jakub, Kwiatkowska Maja, Łosińska Aleksandra, Nowak Ewa, Lackowska Anna, Rydzewska Anna, Durma Agnieszka, Sokal Paweł
Department of Emergency Medicine, Dr John Biziel's Clinical University Hospital No. 2, Bydgoszcz, Poland.
Medical University of Gdańsk, Gdańsk, Poland.
Emerg Med Int. 2023 Aug 18;2023:5571435. doi: 10.1155/2023/5571435. eCollection 2023.
Traumatic brain injury (TBI) is the main cause of disability in the world. Prehospital diagnosis of patients requiring rapid neurosurgical intervention and the earliest possible introduction of procedures preventing secondary brain injuries (SBI) are crucial. . The authors of this paper assumed that certain age groups with specific injuries are more likely to require urgent neurosurgical intervention compared with patients who did not require such an intervention. Out of 54,814 head CT scans, based on the inclusion criteria, 7,864 were selected for the study. Data such as sex, age, the mechanism of injury, comorbid trauma, and abnormal findings in the examination of patients qualified for urgent neurosurgical intervention were analyzed in order to find statistically significant factors through a comparison with all head trauma patients.
Patients qualified for urgent neurosurgical intervention were significantly older compared with the others (63 years vs. 49 years). Patients transferred from the emergency department directly to the operating room were more often admitted to the hospital due to the fall (64.1% vs. 45.1%, = 0.004). The following were observed much more commonly among the patients qualified for urgent neurosurgical intervention than in the entire study group of subjects with traumatic brain injury (TBI), e.g., calf deformity (2.2% vs. 0.1%, = 0.019) and bleeding from the mouth (4.3% vs. 0.0%, < 0.001). On the other hand, superciliary arch wounds were observed much less commonly than in the entire group (0.0% vs. 5%, = 0.221).
Patients admitted directly to the operating neurosurgical room from emergency departments constitute a small percentage of TBI patients, and their prognosis for normal performance status upon discharge is poor. Maximum efforts should be made to distinguish these patients and to start proper treatment even during prehospital care.
创伤性脑损伤（TBI）是全球致残的主要原因。对需要快速神经外科干预的患者进行院前诊断，并尽早采取预防继发性脑损伤（SBI）的措施至关重要。本文作者认为，与不需要此类干预的患者相比，某些特定年龄组且有特定损伤的患者更有可能需要紧急神经外科干预。在54814例头部CT扫描中，根据纳入标准，选择了7864例进行研究。分析了诸如性别、年龄、损伤机制、合并创伤以及符合紧急神经外科干预条件的患者检查中的异常发现等数据，以便通过与所有头部创伤患者进行比较来找出具有统计学意义的因素。
符合紧急神经外科干预条件的患者比其他患者年龄显著更大（63岁对49岁）。从急诊科直接转入手术室的患者因跌倒入院的情况更为常见（64.1%对45.1%，P = 0.004）。与整个创伤性脑损伤（TBI）研究组相比，符合紧急神经外科干预条件的患者中以下情况更为常见，例如小腿畸形（2.2%对0.1%，P = 0.019）和口腔出血（4.3%对0.0%，P < 0.001）。另一方面，眉弓伤口的观察结果比整个组少得多（0.0%对5%，P = 0.221）。
从急诊科直接进入神经外科手术室的患者在TBI患者中占比很小，且他们出院时恢复正常功能状态的预后较差。应尽最大努力识别这些患者，并即使在院前护理期间也开始进行适当治疗。
