Smith Parker D, Shukla Ishav, Azam Faraaz, Trautmann Daniel, Gee Evan, Korb Madison, Pitonak Michael, Srinivasan Srivats, Caruso James P, Caldwell Christie, Hall Kristen, Tamimi Mazin Al, Reisch Joan, Bedros Nicole M, Aoun Salah G
1Department of Neurological Surgery and.
2O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas; and.
J Neurosurg. 2025 Jan 3;142(6):1616-1624. doi: 10.3171/2024.8.JNS241051. Print 2025 Jun 1.
Traumatic hemorrhagic cerebral contusions are a well-established cause of morbidity and mortality in neurosurgery. This study aimed to determine prognostic factors for long-term functional outcomes and longitudinal contusion volume changes in traumatic brain injury (TBI) patients.
Data from 285 patients with traumatic cerebral contusions were retrospectively reviewed to identify variables predictive of initial contusion volume, contusion expansion on short-term follow-up imaging, and functional outcomes according to the modified Rankin Scale (mRS). Predictors of these variables were identified using a stepwise logistic regression analysis.
Older age, larger initial contusion volumes, and lower presenting Glasgow Coma Scale (GCS) scores were associated with worse functional outcomes (mRS score ≥ 3). Patients with contusion volumes ≥ 15 ml at presentation had lower GCS scores and longer ICU stays (in days). Older age (OR 1.043, CI 1.024-1.063), need for a craniotomy or craniectomy (OR 2.562, CI 1.010-6.502), longer ICU stay (OR 1.092, CI 1.034-1.154), and lower total GCS score (OR 0.781, CI 0.729-0.836) were associated with worse functional outcomes. Additionally, lower admission GCS verbal score was a significant predictor of larger initial contusion volume (OR 0.779, 95% CI 0.667-0.911) and contusion expansion during hospitalization (OR 0.649, 95% CI 0.497-0.847).
Functional outcomes in traumatic cerebral contusion patients may be associated with age and admission GCS score, and verbal GCS score may predict initial contusion volume and contusion expansion. These findings supplement an evolving understanding of factors that influence outcomes in patients with cerebral contusions, and further study into the utility of GCS to guide these decisions could help to guide the clinical management of these highly complex patients.
创伤性出血性脑挫裂伤是神经外科中公认的发病和死亡原因。本研究旨在确定创伤性脑损伤（TBI）患者长期功能预后及纵向挫裂伤体积变化的预后因素。
回顾性分析285例创伤性脑挫裂伤患者的数据，以确定预测初始挫裂伤体积、短期随访影像学上挫裂伤扩大以及根据改良Rankin量表（mRS）评估功能预后的变量。使用逐步逻辑回归分析确定这些变量的预测因素。
年龄较大、初始挫裂伤体积较大以及入院时格拉斯哥昏迷量表（GCS）评分较低与较差的功能预后（mRS评分≥3）相关。入院时挫裂伤体积≥15 ml的患者GCS评分较低，ICU住院时间较长（天数）。年龄较大（比值比[OR]1.043，可信区间[CI]1.024 - 1.063）、需要开颅手术或颅骨切除术（OR 2.562，CI 1.010 - 6.502）、ICU住院时间较长（OR 1.092，CI 1.034 - 1.154）以及总GCS评分较低（OR 0.781，CI 0.729 - 0.836）与较差的功能预后相关。此外，入院时GCS言语评分较低是初始挫裂伤体积较大（OR 0.779，95%CI 0.667 - 0.911）和住院期间挫裂伤扩大（OR 0.649，95%CI 0.497 - 0.847）的显著预测因素。
创伤性脑挫裂伤患者的功能预后可能与年龄和入院时GCS评分相关，且言语GCS评分可能预测初始挫裂伤体积和挫裂伤扩大。这些发现补充了对影响脑挫裂伤患者预后因素的不断发展的认识，进一步研究GCS在指导这些决策中的效用有助于指导这些高度复杂患者的临床管理。
