Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study.
Brain Inj
; 35(10): 1267-1274, 2021 08 24.
Article
em En
| MEDLINE
| ID: mdl-34488497
ABSTRACT
OBJECTIVES:
To determine the predicting demographic, clinical and radiological factors for neurosurgical intervention in complicated mild traumatic brain injury (mTBI) patients.METHODS:
Design:
retrospective multicenter cohort study.Participants:
patients aged ≥16 presenting to all level-I trauma centers in Quebec between 09/2016 and 12/2017 with mTBI(GCS 13-15) and complication on initial head CT (intracranial hemorrhage/skull fracture). Procedure Consecutive medical records were reviewed and separated into two groups no neurosurgical intervention and neurosurgical intervention (NSI). Mainoutcome:
neurosurgical intervention.Analysis:
multiple logistic regression model.RESULTS:
Four hundred and seventy-eight patients were included and 40 underwent NSI. One patient had radiological deterioration but no clinical deterioration prior to surgery. Subdural hemorrhage ≥4 mm width (OR3.755 [95% CI1.290-10.928]) and midline shift (OR7.507 [95% CI 3.317-16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR0.312 [95% CI 0.136-0.713]). All other intracranial hemorrhages were not associated with NSI.CONCLUSION:
Radiological deterioration was not associated with the incidence of NSI. Subdural hemorrhage and midline shift should be predicting factors for neurosurgery. Some patients with isolated findings such as subarachnoid hemorrhage could be safely managed in their original center without being transferred to a level-I trauma center.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Concussão Encefálica
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Brain Inj
Assunto da revista:
CEREBRO
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Canadá