Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea.
Neurosurg Rev. 2024 Jun 7;47(1):259. doi: 10.1007/s10143-024-02499-6.
raumatic brain injury (TBI) is a significant global health concern, particularly affecting young individuals, and is a leading cause of mortality and morbidity worldwide. Despite improvements in treatment infrastructure, many TBI patients choose discharge against medical advice (DAMA), often declining necessary surgical interventions. We aimed to investigate the factors that can be associated with DAMA in TBI patients that were recommended to have surgical treatment. This study was conducted at single tertiary university center (2008-2018), by retrospectively reviewing 1510 TBI patients whom visited the emergency room. We analyzed 219 TBI surgical candidates, including 50 declining surgery (refused group) and the others whom agreed and underwent decompressive surgery. Retrospective analysis covered demographic characteristics, medical history, insurance types, laboratory results, CT scan findings, and GCS scores. Statistical analyses identified factors influencing DAMA. Among surgical candidates, 169 underwent surgery, while 50 declined. Age (60.8 ± 17.5 vs. 70.5 ± 13.8 years; p < 0.001), use of anticoagulating medication (p = 0.015), and initial GCS scores (9.0 ± 4.3 vs. 5.3 ± 3.2; p < 0.001) appeared to be associated with refusal of decompressive surgery. Based on our analysis, factors influencing DAMA for decompressive surgery included age, anticoagulant use, and initial GCS scores. Contrary to general expectations and some previous studies, our analysis revealed that the patients' medical conditions had a larger impact than socioeconomic status under the Korean insurance system, which fully covers treatment for TBI. This finding provides new insights into the factors affecting DAMA and could be valuable for future administrative plans involving national insurance.
创伤性脑损伤（TBI）是一个重大的全球健康问题，尤其影响年轻人，是全球范围内死亡率和发病率的主要原因。尽管治疗基础设施有所改善，但许多 TBI 患者选择违反医嘱出院（DAMA），经常拒绝必要的手术干预。我们旨在研究与推荐接受手术治疗的 TBI 患者的 DAMA 相关的因素。这项研究在一个单一的三级大学中心进行（2008-2018 年），通过回顾性分析 1510 名就诊急诊室的 TBI 患者。我们分析了 219 名 TBI 手术候选者，包括 50 名拒绝手术的患者（拒绝组）和其他同意并接受减压手术的患者。回顾性分析涵盖了人口统计学特征、病史、保险类型、实验室结果、CT 扫描结果和 GCS 评分。统计分析确定了影响 DAMA 的因素。在手术候选者中，169 名接受了手术，而 50 名拒绝了手术。年龄（60.8±17.5 岁比 70.5±13.8 岁；p<0.001）、使用抗凝药物（p=0.015）和初始 GCS 评分（9.0±4.3 分比 5.3±3.2 分；p<0.001）似乎与拒绝减压手术有关。根据我们的分析，影响减压手术 DAMA 的因素包括年龄、抗凝药物使用和初始 GCS 评分。与一般预期和一些先前的研究相反，我们的分析表明，在韩国保险制度下，患者的医疗状况比社会经济地位对 DAMA 的影响更大，该制度完全涵盖了 TBI 的治疗。这一发现为影响 DAMA 的因素提供了新的见解，并可能对涉及国家保险的未来行政计划具有价值。
