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额窦骨折与创伤性脑损伤:外科治疗中死亡率的预测因素

Frontal Sinus Fractures and Traumatic Brain Injury: Predictors of Mortality in Surgical Management.

作者信息

Trejo Eduardo, García Patricio, Ortega Diego A, González Karla C, Botello Edgar, Hernández Gamaliel, Morales Jesús A, Martínez Ángel R

机构信息

School of Medicine and University Hospital "Dr. José E. González" Universidad Autónoma de Nuevo León, Monterrey, Mexico.

Department of Neurosurgery and Endovascular Therapy, Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Mexico.

出版信息

Craniomaxillofac Trauma Reconstr. 2024 Dec;17(4):314-323. doi: 10.1177/19433875241229882. Epub 2024 Jan 22.

Abstract

STUDY DESIGN

This is anobservational, retrospective, analytical study.

OBJECTIVE

The aim was todetermine a statistical basis for a future line of research based on the epidemiology of a center located in a developing country, as well as defining indirect mortality predictors.

METHODS

Clinical files were reviewed based on diagnosis of Traumatic Brain Injury (TBI), according to the International Classification of Diseases 10th Revision (ICD-10). Sociodemographic variables as well as treatment modality of the condition during hospitalization was recorded. The patient sample was divided into two groups. Student's T-test was performed in variables with normal distribution and Chi-square test in independent random variables with standard normal distribution. For correlations, Pearson's correlation coefficient was used, taking the -value <.05 as statistically significant.

RESULTS

A total of 150 participants were included in this study, from which 125 were male (83.3%). The average age was 28.58 ± 16.55 years. The median hospitalization time was 9 days. Forty-five patients (30%) were treated conservatively. Fifteen patients died during hospitalization. The factors considered as predictors of mortality in the general population corresponded to Motor Vehicle Accident, Frontonasal Duct Obstruction, Neuroinfection, Glasgow Coma Scale (GCS) at admission, as well as GCS at discharge. In the patients who underwent surgery, predictors of mortality corresponded to Motor Vehicle Accident, Bilateral Frontal Craniotomy, Surgical Bleeding >475 cc, Neuroinfection, as well as GCS at admission and discharge.

CONCLUSIONS

The creation of adequate diagnostic and therapeutic algorithms in traumatic brain injury management is needed, especially in developing countries. More specific studies are needed, particularly analytical and multicentric studies, which may allow the development of these algorithms.

摘要

研究设计

这是一项观察性、回顾性分析研究。

目的

旨在基于一个位于发展中国家的中心的流行病学情况,确定未来一系列研究的统计学依据,并确定间接死亡率预测指标。

方法

根据《国际疾病分类第10版》(ICD - 10)对创伤性脑损伤(TBI)的诊断对临床档案进行回顾。记录社会人口统计学变量以及住院期间病情的治疗方式。将患者样本分为两组。对正态分布的变量进行学生t检验,对具有标准正态分布的独立随机变量进行卡方检验。对于相关性分析,使用皮尔逊相关系数,将p值 < 0.05视为具有统计学意义。

结果

本研究共纳入150名参与者,其中125名男性(83.3%)。平均年龄为28.58 ± 16.55岁。中位住院时间为9天。45名患者(30%)接受保守治疗。15名患者在住院期间死亡。在一般人群中被视为死亡率预测指标的因素包括机动车事故、鼻泪管阻塞、神经感染、入院时的格拉斯哥昏迷量表(GCS)以及出院时的GCS。在接受手术的患者中,死亡率预测指标包括机动车事故、双侧额叶开颅手术、手术出血量>475 cc、神经感染以及入院和出院时的GCS。

结论

在创伤性脑损伤管理中需要创建适当的诊断和治疗算法,尤其是在发展中国家。需要进行更具体的研究,特别是分析性和多中心研究,这可能有助于这些算法的开发。

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本文引用的文献

1
Frontal Sinus Fractures: Management and Complications.额窦骨折:治疗与并发症
Craniomaxillofac Trauma Reconstr. 2019 Sep;12(3):241-248. doi: 10.1055/s-0038-1675560. Epub 2019 Feb 19.
2
Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches.额窦骨折:不断发展的临床考量与手术方法
Craniomaxillofac Trauma Reconstr. 2019 Jun;12(2):85-94. doi: 10.1055/s-0039-1678660. Epub 2019 Feb 4.
7
Management of frontal sinus fractures.额窦骨折的处理
Plast Reconstr Surg. 2007 Dec;120(7 Suppl 2):32S-48S. doi: 10.1097/01.prs.0000260732.58496.1b.

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