Association of skull fracture with in-hospital mortality in severe traumatic brain injury patients.

Autor: Fujiwara G; Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan. Electronic address: gakufujiwara@hotmail.com., Okada Y; Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan; Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. Electronic address: yokada-kyf@umin.ac.jp., Ishii W; Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan. Electronic address: wataruaug0804@lily.ocn.ne.jp., Iizuka R; Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan. Electronic address: iizukar@kyoto2.jcr.or.jp., Murakami M; Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan., Sakakibara T; Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan. Electronic address: t-sakaki@msf.biglobe.ne.jp., Yamaki T; Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan. Electronic address: ytaru@wf6.so-net.ne.jp., Hashimoto N; Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2021 Aug; Vol. 46, pp. 78-83. Date of Electronic Publication: 2021 Mar 11.
DOI: 10.1016/j.ajem.2021.03.020
Abstrakt: Introduction: To identify the association between skull fracture (SF) and in-hospital mortality in patients with severe traumatic brain injury (TBI).
Materials and Methods: This multicenter cohort study included a retrospective analysis of data from the Japan Trauma Data Bank (JTDB). JTDB is a nationwide, prospective, observational trauma registry with data from 235 hospitals. Adult patients with severe TBI (Glasgow Coma Scale <9, head Abbreviated Injury Scale (AIS) ≥ 3, and any other AIS < 3) who were registered in the JTDB between January 2004 and December 2017 were included in the study. Patients who (a) were < 16 years old, (b) developed cardiac arrest before or at hospital arrival, and (c) had burns and penetrating injuries were excluded from the study. In-hospital mortality was the primary outcome assessed. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) of SF and their 95% confidence intervals (CIs) for in-hospital mortality.
Results: A total of 9607 patients were enrolled [median age: 67 (interquartile range: 50-78) years] in the study. Among those patients, 3574 (37.2%) and 6033 (62.8%) were included in the SF and non-SF groups, respectively. The overall in-hospital mortality rate was 44.1% (4238/9607). A multivariate analysis of the association between SF and in-hospital mortality yielded a crude OR of 1.63 (95% CI: 1.47-1.80). A subgroup analysis of the association of skull vault fractures, skull base fractures, and both fractures together with in-hospital mortality yielded adjusted ORs of 1.60 (95% CI: 1.42-1.98), 1.40 (95% CI: 1.16-1.70), and 2.14 (95% CI: 1.74-2.64), respectively, relative to the non-SF group.
Conclusions: This observational study showed that SF is associated with in-hospital mortality among patients with severe TBI. Furthermore, patients with both skull base and skull vault fractures were associated with higher in-hospital mortality than those with only one of these injuries.
Competing Interests: Declaration of Competing Interest Nothing to disclose.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: