Acute subdural hematoma after isolated traumatic brain injury: associated factors and prediction of lethal outcome : [spausdintas pranešimas žurnale]

Abstract

Introduction: The aim of this study was to determine associated factors with lethal outcome also prediction of it in case of acute subdural hematoma (ASH) after isolated traumatic brain injury (ITBI). Methods: Retrospective analysis of 162 patients with ASH after ITBI treated in Neurosurgical Intensive Care Unit in Hospital Kaunas Clinics of Lithuanian University of Health Sciences during two years was carried out. Results: Sixty–seven patients (41%) of 162 have died with ASH after ITBI. Twelve patients (31%) of 39 have died in age group of < = 44 years, 16 patients (37%) of 43 in group of 45 – 54 years, 14 patients (36%) of 39 in group of 55 – 64 years, but 25 patients (61%) of 41 in group of > = 65 years, p < 0.003. Twenty–four patients (26%) of 93 have died with pupillary light reflex and 43 patients (62%) of 69 without of it, p < 0.001. Five patients (25%) of 20 have died in group of Glasgow Coma Scale (GCS) score 12 – 15, 5 patients (20%) of 25 in group of 9 – 11, but 57 patients (49%) of 117 in group of 3 – 8, p < 0.002. Twenty–one patient (28%) of 75 has died with white blood cell count <10.1 x 10 9/l, but 46 patients (53%) of 87 with > = 10.1 x 10 9/l, p < 0.001. Five patients (17%) of 30 have died with glycemia 3.3 – 5.5 mmol/l and 62 patients (47%) of 132 with glycemia > = 5.6 mmol/l, p < 0.001. One patient (5%) of 22 has died in group of APACHE II score < = 10 points, 12 patients (24%) of 50 in group of score 11 – 15, but 54 patients (60%) of 90 in group of score > = 16, p < 0.001. Fifty–two patients (63%) of 82 have died in the group of estimated lethal outcome risk >25%, p < 0.001 (0.95CI: 0.53 – 0.74) and prognostic test sensitivity was found to be 78%, specificity 76%. Conclusions: The mortality rate of acute subdural hematoma after isolated traumatic brain injury was 41%. Factors associated with lethal outcome were e. [...].