少即是多：简化改良颅脑损伤指南中孤立性创伤性蛛网膜下腔出血的管理。
Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury guidelines.
机构信息
Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA.
出版信息
Am J Surg. 2024 Dec;238:115973. doi: 10.1016/j.amjsurg.2024.115973. Epub 2024 Sep 17.
BACKGROUND
Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.
METHODS
A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and pre-injury antiplatelet/anticoagulant use.
RESULTS
276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 % of patients. A total of 19 (8.6 %) patients had radiographic progression. Six (2.2 %) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.
CONCLUSIONS
There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.
背景
孤立性创伤性蛛网膜下腔出血（iTSAH）患者根据改良脑损伤指南（mBIG）进行管理。本研究旨在描述 iTSAH 患者并分析其临床结果。
方法
对创伤性 iTSAH 患者进行回顾性分析。排除标准为格拉斯哥昏迷量表（GCS）<13 和术前抗血小板/抗凝治疗。
结果
在 8 年的研究期间共确定了 276 名患者。中位数进行了 2 次头部 CT 扫描。80.4%的患者获得了神经外科会诊。共有 19 名（8.6%）患者出现影像学进展。6 名（2.2%）患者出现神经功能恶化。无患者需要手术干预或再次入院。没有与 iTSAH 相关的死亡。
结论
尽管部分患者存在影像学或神经功能进展，但没有 iTSAH 患者需要神经外科会诊。这些患者可能不需要重复头部 CT 扫描或神经外科会诊，这需要在 mBIG 中改变 SAH 的定义。
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