Severe Traumatic Brain Injury Requiring Surgical Decompression in the Young Adult: Factors Influencing Morbidity and Mortality - A Retrospective Analysis.

Autor:	Ogunlade J; Neurosurgery, Riverside University Health System Medical Center, Riverside, USA., Elia C; Neurosurgery, Riverside University Health System Medical Center, Riverside, USA., Duong J; Neurosurgery, Riverside University Health System Medical Center, Rancho Cucamonga, USA., Yanez PJ; Clinical Research, Harvard University, Boston, USA., Dong F; Clinical Research, Western University of Health Sciences, Pomona, USA., Wacker MR; Neurosurgery, Arrowhead, Moreno Valley, USA., Menoni R; Neurosurgery, Arrowhead, Colton, USA., Goldenberg T; Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, USA., Miulli DE; Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2018 Jul 24; Vol. 10 (7), pp. e3042. Date of Electronic Publication: 2018 Jul 24.
DOI:	10.7759/cureus.3042
Abstrakt:	Introduction: Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young adults. The clinical outcome may also be difficult to predict. We aim to identify the factors predictive of favorable and unfavorable clinical outcomes for youthful patients with severe TBI who have the option of surgical craniotomy or surgical craniectomy. Methods: A retrospective review at a single Level II trauma center was conducted, identifying patients aged 18 to 30 years with isolated severe TBI with a mass-occupying lesion requiring emergent (< 6 hours from time of arrival) surgical decompression. Glasgow Coma Scale (GCS) score on arrival, type of surgery performed, mechanism of injury, length of hospital stay, Glasgow Outcome Score (GOS), mortality, and radiographic findings were recorded. A favorable outcome was a GOS of four or five at 30 days post operation, while an unfavorable outcome was GOS of 1 to 3. Results: Fifty patients were included in the final analysis. Closed head injuries (skull and dura intact), effacement of basal cisterns, disproportional midline shift (MLS), and GCS 3-5 on arrival all correlated with statistically significant higher rate of mortality and poor 30-day functional outcome. All mortalities (6/50 patients) were positive for each of these findings. Conclusions: Closed head injuries, the presenting GCS 3-5, the presence of MLS disproportional to the space occupying lesion (SOL), and effacement of basal cisterns on the initial computed tomography of the head all correlated with unfavorable 30-day outcome. Future prospective studies investigating a larger cohort may provide further insight into patients suffering from severe TBI. Competing Interests: The authors have declared that no competing interests exist.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu