Bed Rest as a Protective Factor for Subdural Hematoma in Spontaneous Intracranial Hypotension: A Retrospective Study
Bed Rest as a Protective Factor for Subdural Hematoma in Spontaneous Intracranial Hypotension: A Retrospective Study
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卧床休息作为自发性颅内低血压硬膜下血肿的保护因素：一项回顾性研究
作者：
Qiongbin Zhu;Bo Huang;Lei He;Xingyue Hu
背景：硬膜下血肿（SDH）是自发性低颅压（SIH）患者潜在的危及生命的并发症。虽然卧床休息是保守治疗的基础。没有明确的证据表明SIH患者卧床休息与SDH后期并发症之间存在相关性。目的：本研究旨在评估SIH患者卧床休息与SDH发展之间的关系。研究设计：在2013年3月至2019年12月期间进行了一项回顾性研究。纳入420例首次诊断为SIH的成人患者。记录临床表现和影像学结果。累积卧床时间（小时）用于显示卧床休息强度。对随访期间的临床结局进行评估。方法：使用卡方检验比较分类数据，使用Mann-Whitney U检验或Kruskal-Wallis检验比较连续数据。采用后向逐步考克斯比例风险回归模型，在单变量分析中调整SDH和非SDH之间不同的混杂因素，以估计SDH的累积卧床时间的风险。进行分层考克斯回归以排除治疗方案的影响。结果：420例SIH患者中，SDH组88例（21.0%），无SDH（NSDH）组332例（79.0%）。在SIH中，累积卧床时间（小时）是SDH的保护因素（HR = 0.997; p < 0.001）。分层考克斯回归分析显示，无论是在入院前接受保守治疗的患者（HR = 0.997; p < 0.001）还是在入院前未接受保守治疗的患者（HR = 0.996; p = 0.061）中，累积卧床时间仍然是SDH的保护因素。年龄（HR = 1.029，95%CI，1.009-1.050; p = 0.004）和直立性头痛（HR = 4.770，95%CI，2.177-10.450; p < 0.001）是SIH患者SDH的危险因素。SDH组的住院时间、硬膜外血补片（EBP）治疗和重复EBP治疗的临床结局均高于SDH组。两组患者的复诊率相似。局限性：回顾性研究易受不同放射学程序和治疗策略的影响。基于患者记忆的卧床休息评分易受识别和报告偏倚的影响。这是一项单中心研究，样本量不大。卧床休息量表的有效性尚未在其他研究中进行评估。结论：卧床休息是SIH患者SDH的保护因素。随着时间的延长和适当的治疗，SIH合并SDH患者可以获得良好的长期预后。
Background: Subdural hematoma (SDH) is a potentially life-threatening complication in spontaneous intracranial hypotension (SIH) patients. Though bed rest is the basis of conservative treatment. No clear evidence exists regarding the association between bed rest and the later complication of SDH in SIH patients..Objectives: This study aimed to evaluate the association between bed rest and SDH development in SIH patients..Study Design: A retrospective study was conducted between March 2013 to December 2019. 420 adult patients with firstly diagnosed SIH were enrolled. Clinical presentations and radiographic findings were recorded. Cumulative duration of bed rest (hours) was used to reveal the bed rest intensity. The clinical outcomes during follow-up were assessed..Methods: Categorical data were compared using chi-square tests and continuous data were compared using Mann-Whitney U test or Kruskal-Wallis test. A backwards stepwise Cox proportional hazard regression models adjusted with confounders which differed between SDH and non-SDH in univariate analysis was used to estimate the risk of cumulative duration of bed rest for SDH. Stratified COX regression was performed to exclude the effect of treatment algorithm..Results: Of the 420 patients with SIH, 88 (21.0%) were in SDH group and 332 (79.0%) were in no SDH (NSDH) group. Cumulative duration of bed rest (hours) was a protective factor for SDH in SIH (HR = 0.997; p < 0.001). Stratified COX regression analysis showed that cumulative duration of bed rest remained a protective factor for SDH both in patients who received conservative treatment before admission (HR = 0.997; p < 0.001) and in those who did not (HR = 0.996; p = 0.061). Age (HR = 1.029, 95% CI, 1.009-1.050; p = 0.004) and orthostatic headache (HR = 4.770, 95% CI, 2.177-10.450; p < 0.001) were risk factors for SDH in SIH. The clinical outcomes, including length of hospital stay, epidural blood patch (EBP) therapy and repeated EBP therapy were higher in SDH group. While revisit rate was similar between the two groups..Limitations: Retrospective studies are susceptible to different radiological procedures and therapeutic strategies. Bed rest score based on the patient’s memory are susceptible to recognition and reporting bias. This is a single-center study and the sample size is not large. The validity of the bed rest scale has not been previously evaluated in other study. .Conclusions: Bed rest was a protective factor for SDH in SIH patients. With more time and proper treatment, SIH patients with SDH can achieve good prognosis in the long term.