PATIENTS WITH MODERATE HEAD INJURY
| Autor: | Giuseppe Trincia, L. Cristofori, Domenico D'Avella, Filippo Flavio Angileri, Sergio M. Gaini, Luca Denaro, Christian Compagnone, Franco Servadei, Fernanda Tagliaferri, Roberto Stefini, G L Brambilla, Roberto Delfini, Giustino Tomei, Carlo Conti, Alessandro Ducati, Francesco Tomasello |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Computed tomographic scan Moderate head injury Neuroworsening Outcome Subarachnoid hemorrhage Adolescent medicine.medical_treatment Neurosurgery Glasgow Outcome Scale Disability Evaluation Young Adult Outcome Assessment Health Care Confidence Intervals Odds Ratio medicine Craniocerebral Trauma Humans Prospective Studies Prospective cohort study Craniotomy Aged Aged 80 and over Settore MED/27 - Neurochirurgia business.industry Head injury Glasgow Coma Scale Odds ratio Middle Aged medicine.disease Confidence interval Surgery Italy Anesthesia Disease Progression Female Neurology (clinical) Tomography X-Ray Computed business Forecasting |
| Zdroj: | Neurosurgery. 64:690-697 |
| ISSN: | 0148-396X |
| Popis: | Objective To analyze the risk factors of worst outcome associated with moderate head injury. Methods Data on patients with moderate head injury were collected prospectively in 11 Italian neurosurgical units over a period of 18 months. Patients older than 18 years with blunt head injury and at least one Glasgow Coma Scale (GCS) score between 9 and 13 were enrolled. The outcome was determined at 6 months using the Glasgow Outcome Scale. Results We analyzed 315 patients. Initial computed tomographic scans showed a diffuse injury type I or II in 63%, a mass lesion in 35%, and traumatic subarachnoid hemorrhage in 42% of the patients. The risk of progression toward a mass lesion was 23% when the admission computed tomographic scan showed diffuse injury type I or II. An emergency craniotomy was performed in 22% of the patients, delayed surgery was performed in 14%, and both were performed in 25%. A favorable outcome was obtained in 74% of the patients. When the GCS score was 9 or 10, the predictor of worst outcome was a motor GCS score of 4 or lower (odds ratio [OR], 8.08; 95% confidence interval [CI], 1.22-67.35; P = 0.008), but when the GCS score was 11 to 13, the factors associated with worst outcome were neuroworsening (OR, 3.43; 95% CI, 1.45-8.17; P = 0.002), seizures (OR, 7.94; 95% CI, 1.18-64.48; P = 0.02), and medical complications (OR, 4.24; 95% CI, 1.74-10.33; P = 0.0006). Conclusion There is a high percentage of surgery and worsening on computed tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and medical complications as outcome predictors were more strongly associated with a GCS score of 11 to 13, whereas a low motor GCS score was more outcome-related in patients with GCS scores of 9 and 10. |
| Databáze: | OpenAIRE |
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