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Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury.
Chen, Di-You; Wu, Peng-Fei; Zhu, Xi-Yan; Zhao, Wen-Bing; Shao, Shi-Feng; Xie, Jing-Ru; Yuan, Dan-Feng; Zhang, Liang; Li, Kui; Wang, Shu-Nan; Zhao, Hui.
Afiliação
  • Chen DY; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Wu PF; Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China.
  • Zhu XY; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Zhao WB; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Shao SF; Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Xie JR; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Yuan DF; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Zhang L; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Li K; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
  • Wang SN; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China. Electronic address: wangshunan@tmmu.edu.cn.
  • Zhao H; Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China. Electronic address: box.zhaohui@163.com.
Chin J Traumatol ; 27(3): 153-162, 2024 May.
Article em En | MEDLINE | ID: mdl-38458896
ABSTRACT

PURPOSE:

Cerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries.

METHODS:

This case-control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median (Q1, Q3). Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve.

RESULTS:

According to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% confidence interval (CI) 2.08 - 25.42, p = 0.002), 2.85 (95% CI 1.11 - 7.31, p = 0.030), 2.62 (95% CI 1.12 - 6.13, p = 0.027), 2.44 (95% CI 1.25 - 4.76, p = 0.009), and 1.5 (95% CI 1.10 - 2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ2 = 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ2 = 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively.

CONCLUSION:

Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Edema Encefálico / Acidentes de Trânsito / Lesões Encefálicas Traumáticas Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Edema Encefálico / Acidentes de Trânsito / Lesões Encefálicas Traumáticas Idioma: En Ano de publicação: 2024 Tipo de documento: Article