Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design.
Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design.
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DOI：
10.1186/s12893-023-02227-9
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发表时间：
2023-10-25
期刊：
影响因子：
1.9
通讯作者：
Galukande, Moses
中科院分区：
文献类型：
--
作者：
Kamabu, Larrey Kasereka;Bbosa, Godfrey S.;Lekuya, Herve Monka;Cho, Eugene J.;Kyaruzi, Victor Meza;Nyalundja, Arsene Daniel;Deng, Daniel;Sekabunga, Juliet Nalwanga;Kataka, Louange Maha;Obiga, Doomwin Oscar Deogratius;Kiryabwire, Joel;Kaddumukasa, Martin N.;Kaddumukasa, Mark;Fuller, Anthony T.;Galukande, Moses
关键词：
创伤性脑损伤（TBI）后的膨胀性颅内血肿（EIH）仍然是乌干达的一个公共卫生问题。关于TBI患者神经外科结局的数据有限。本研究调查了Mulago国家转诊医院（MNRH）TBI患者的神经外科结局和EIH相关风险因素。采用前瞻性队列研究共入组了324例受试者。使用研究问卷收集社会人口统计学、风险因素和并发症。研究参与者被随访了180天。依次进行单变量、多变量、考克斯回归分析、卡普兰·梅尔生存曲线和对数秩检验。在95%置信区间（CI）下P值< 0.05被认为是统计学显著的。324例颅内血肿患者中，男性占80.6%。研究参与者的平均年龄为37.5 ± 17.4岁。EIH患病率为59.3%（0.59（95%CI：0.54 - 0.65））。年龄在39岁及以上的参与者; PR = 1.54（95%CI：1.20 - 1.97; P = 0.001），吸烟者PR = 1.21（95%CI：1.00 - 1.47; P = 0.048），且存在漩涡征PR = 2.26（95%CI：1.29 - 3.95; P = 0.004）被发现具有较高的EIH风险。Kaplan Meier生存曲线显示16个月随访时死亡率为53.4%（95%CI：28.1 - 85.0）。多因素考克斯回归分析显示，死亡率的预测因素是高龄、MAP> 95 mmHg、GCS低、并发症如感染、痉挛、伤口裂开、CSF渗漏、GOS < 3、QoLIBRI < 50、SDH、挫伤和EIH。EIH在乌干达RTA后很常见，发生率为59.3%，死亡率高出16个月。年龄大于39岁、吸烟、有严重全身性疾病和漩涡征是独立的危险因素。高龄、MAP> 95 mmHg、GCS低、并发症如感染、痉挛、伤口裂开、脑脊液漏、GOS < 3、QoLIBRI < 50、ASDH和挫伤是死亡率的预测因素。这些发现意味着所有颅内血肿（IH）患者都需要密切监测，并在初次CT扫描后的特定时间内进行重复CT扫描。我们建议制定一个具体的手术和医疗干预方案，可用于中度和重度EIH风险的患者。在线版本包含补充材料，可通过10.1186/s12893-023-02227-9获得。
Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH. The online version contains supplementary material available at 10.1186/s12893-023-02227-9.
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影响因子：
8.2
作者：
An SJ;Kim TJ;Yoon BW
通讯作者：
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Zuccarello, Mario
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Boulouis G;Morotti A;Brouwers HB;Charidimou A;Jessel MJ;Auriel E;Pontes-Neto O;Ayres A;Vashkevich A;Schwab KM;Rosand J;Viswanathan A;Gurol ME;Greenberg SM;Goldstein JN
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Goldstein JN
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