Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy
Autor: | Seong Ho Kim, Youngbeom Seo, Ikchan Jeon, Dongwoo Yu, Jung Ho Hong |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male Decompressive Craniectomy medicine.medical_specialty Adolescent Traumatic brain injury medicine.medical_treatment Glasgow Outcome Scale Kaplan-Meier Estimate 030218 nuclear medicine & medical imaging Young Adult 03 medical and health sciences 0302 clinical medicine Skull fracture Brain Injuries Traumatic medicine Humans Aged Retrospective Studies Neuroradiology Aged 80 and over Observer Variation Cistern business.industry Odds ratio Middle Aged Prognosis medicine.disease Surgery Logistic Models Treatment Outcome Multivariate Analysis Female Decompressive craniectomy Neurology (clinical) Tomography X-Ray Computed business Crural Cistern 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | Acta Neurochirurgica. 163:1371-1381 |
ISSN: | 0942-0940 0001-6268 |
Popis: | Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients. We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1–4, unfavorable; 5–8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality. Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032–1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247–126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234–94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359–17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747–29.054; p = 0.000). Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI. |
Databáze: | OpenAIRE |
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