Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources
Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources
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DOI：
10.4103/0976-3147.172151
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发表时间：
2016-01-01
影响因子：
1.4
通讯作者：
Adelson, P. David
中科院分区：
文献类型：
--
作者：
Charry, Jose D.;Rubiano, Andres M.;Adelson, P. David
简介：严重创伤性脑损伤（sTBI）是一种在拉丁美洲，特别是在哥伦比亚造成严重死亡和残疾的疾病。本研究的目的是评价sTBI患者的12个月临床结局，这些患者在哥伦比亚的一所大学医院接受了4年的早期颅骨减压（ECD）作为损伤控制（DC）治疗的主要程序。材料与方法：对106例接受ECD手术的患者的数据库进行了分析，并根据神经创伤中DC的策略进行了管理。评估变量，并根据伤后12个月的格拉斯哥结局评分（GOS）确定患者结局。这用于生成具有“有利”（GOS为4或5）或“不利”（GOS为1-3）结局的二分变量;采用卡方、Wilcoxon-Mann-Whitney和Fisher检验进行方差分析。结果如下：术后12个月，70例患者GOS 4-5分，总生存率74.6%（66.1%），患者的不良结局与以下因素相关：闭合性创伤，损伤严重度评分> 16，基底池闭塞，硬膜下血肿是入院时计算机断层扫描观察到的主要损伤，在急诊室观察到无反应性瞳孔。结论：在哥伦比亚一家神经监测资源有限的大学医院，采用ECD治疗的sTBI患者的12个月结局显示了重要的生存率，GOS的临床结局指标良好。
Introduction: Severe traumatic brain injury (sTBI) is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD) as the main procedure for damage control (DC) therapy, performed in a University Hospital in Colombia over a 4-year period. Materials and Methods: A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS) at 12 months postinjury. This was used to generate a dichotomous variable with "favorable" (GOS of 4 or 5) or "unfavorable" (GOS of 1-3) outcomes; analysis of variance was performed with the Chi-square, Wilcoxon-Mann-Whitney and Fisher tests. Results: An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4-5) was found in 70 patients (66.1%), Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score > 16, obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department. Conclusion: Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS.