Mismatch between midline shift and hematoma thickness as a prognostic factor of mortality in patients sustaining acute subdural hematoma.

Autor:	de Souza MR; Department of Medicine, Mato Grosso State University, Caceres, Mato Grosso, Brazil., Fagundes CF; Department of Medicine, Mato Grosso State University, Caceres, Mato Grosso, Brazil., Solla DJF; Department of Neurology, University of São Paulo, São Paulo, Brazil.; Department of Neurology, University of Cambridge, Cambridge, UK., da Silva GCL; Department of Medicine, Mato Grosso State University, Caceres, Mato Grosso, Brazil., Barreto RB; Department of Medicine, Mato Grosso State University, Caceres, Mato Grosso, Brazil., Teixeira MJ; Department of Neurology, University of São Paulo, São Paulo, Brazil., Oliveira de Amorim RL; Department of Neurology, University of São Paulo, São Paulo, Brazil., Kolias AG; Department of Clinical Neuroscience - Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK., Godoy D; Intensive Care Unit, San Juan Bautista Hospital, San Fernando del Valle de Catamarca, Argentina., Paiva WS; Department of Neurology, University of São Paulo, São Paulo, Brazil.; Department of Neurology, University of Cambridge, Cambridge, UK.
Jazyk:	angličtina
Zdroj:	Trauma surgery & acute care open [Trauma Surg Acute Care Open] 2021 May 21; Vol. 6 (1), pp. e000707. Date of Electronic Publication: 2021 May 21 (Print Publication: 2021).
DOI:	10.1136/tsaco-2021-000707
Abstrakt:	Background: Acute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country. Methods: This was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (<0.00, 0.01-3, and >3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated. Results: A total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI >3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively. Conclusions: The present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH. Level of Evidence: Level III, epidemiological study. Competing Interests: Competing interests: DJFS reports grants and non-financial support from National Institute for Health Research (NIHR), during the conduct of the study. RLOdA reports grants from the National Council for Scientific and Technological Development (CNPq), Brazil, during the conduct of the study. AGK reports grants and non-financial support from NIHR, grants and non-financial support from the School of Clinical Medicine, University of Cambridge, and grants and non-financial support from Royal College of Surgeons of England, during the conduct of the study. WSP reports grants and non-financial support from NIHR, during the conduct of the study. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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