Yasuda Masaki, Ohtake Makoto, Akimoto Taisuke, Okano Masayuki, Imanishi Yuya, Kawasaki Takafumi, Suenaga Jun, Sakata Katsumi, Takeuchi Ichiro, Yamamoto Tetsuya
Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan.
Neurotrauma Rep. 2025 Apr 18;6(1):336-344. doi: 10.1089/neur.2024.0167. eCollection 2025.
Head trauma accompanied by circulatory failure is a rare but severe condition, and few reports regarding its prognosis or initial treatment strategies have been published. We aimed to evaluate the prognostic factors and treatment strategies for patients with head trauma and vital signs of shock. We included 415 consecutive patients with head trauma (Abbreviated Injury Scale [AIS] score ≥3) who were transported to our institution from January 2017 to December 2023. These patients were divided into shock and non-shock groups. Data on their background, vital signs at presentation, trunk injury status, surgical intervention, and hematological findings were examined. A retrospective analysis was conducted with the modified Rankin Scale score after 3 months as the primary outcome. The patients' mean age was 53.9 ± 24.4 years, 304 (73.3%) were male, 265 (63.9%) experienced severe trauma (injury severity score ≥16), 124 (29.9%) had multiple trauma (AIS score ≥3 at two or more locations), and 59 (14.2%) had accompanying vital signs of shock (shock index >1). Multivariable analysis revealed that older age ( < 0.0001), a lower Glasgow Coma Scale (GCS) score ( < 0.0001), elevated D-dimer levels ( = 0.0077), and pupillary abnormalities ( = 0.038) were independently associated with a poor prognosis in the non-shock group. In the shock group, older age ( = 0.0037) and neurosurgical intervention ( = 0.012) were independent prognostic factors. In contrast to those in the non-shock group, the GCS score and D-dimer levels were not useful prognostic factors in the shock group. The optimal cut-off age for prognosis was 64 years (area under the receiver operating characteristic curve: 0.752; sensitivity: 0.670, specificity: 0.777). The prognosis was significantly worse in the shock group when neurosurgery was required, suggesting that developing a treatment strategy aimed at more rapidly reducing intracranial pressure is essential, especially for patients under 64 years old with circulatory failure.
伴有循环衰竭的头部创伤是一种罕见但严重的病症，关于其预后或初始治疗策略的报道很少。我们旨在评估头部创伤且有休克生命体征患者的预后因素和治疗策略。我们纳入了2017年1月至2023年12月期间连续收治的415例头部创伤患者（简明损伤定级标准[AIS]评分≥3）。这些患者被分为休克组和非休克组。对他们的背景、就诊时的生命体征、躯干损伤状况、手术干预及血液学检查结果进行了分析。以3个月后的改良Rankin量表评分作为主要结局进行回顾性分析。患者的平均年龄为53.9±24.4岁，男性304例（73.3%），265例（63.9%）经历严重创伤（损伤严重度评分≥16），124例（29.9%）有多处创伤（两个或更多部位的AIS评分≥3），59例（14.2%）伴有休克生命体征（休克指数>1）。多变量分析显示，在非休克组中，年龄较大（<0.0001）、格拉斯哥昏迷量表（GCS）评分较低（<0.0001）、D-二聚体水平升高（=0.0077）及瞳孔异常（=0.038）与预后不良独立相关。在休克组中，年龄较大（=0.0037）和神经外科干预（=0.012）是独立的预后因素。与非休克组不同，GCS评分和D-二聚体水平在休克组中不是有用的预后因素。预后的最佳截断年龄为64岁（受试者工作特征曲线下面积：0.752；敏感性：0.670，特异性：0.777）。当需要进行神经外科手术时，休克组的预后明显更差，这表明制定旨在更快降低颅内压的治疗策略至关重要，尤其是对于64岁以下伴有循环衰竭的患者。
