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). Main outcome: 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 (OR:3.755 [95% CI:1.290–10.928]) and midline shift (OR:7.507 [95% CI: 3.317–16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR:0.312 [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.

中文翻译：

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复杂轻度创伤性脑损伤患者神经外科干预的预测因素：一项回顾性队列研究

摘要

目标

确定复杂轻度创伤性脑损伤 (mTBI) 患者神经外科干预的人口统计学、临床和放射学因素。

方法

设计：回顾性多中心队列研究。参与者：在 09/2016 至 12/2017 期间在魁北克所有一级创伤中心就诊的 16 岁以上患有 mTBI（GCS 13-15）和初始头部 CT 并发症（颅内出血/颅骨骨折）的患者。程序：审查连续的医疗记录并将其分为两组：无神经外科干预和神经外科干预 (NSI)。主要结果：神经外科干预。分析：多元逻辑回归模型。

结果

包括 478 名患者，40 名接受了 NSI。一名患者在手术前有放射学恶化但没有临床恶化。硬膜下出血 ≥ 4 mm 宽度 (OR:3.755 [95% CI:1.290–10.928]) 和中线偏移 (OR:7.507 [95% CI: 3.317–16.989]) 增加了 NSI 的风险。蛛网膜下腔出血与较低的 NSI 风险相关（OR：0.312 [95% CI：0.136–0.713]）。所有其他颅内出血均与 NSI 无关。

结论

放射学恶化与 NSI 的发生率无关。硬膜下出血和中线移位应该是神经外科手术的预测因素。一些有蛛网膜下腔出血等孤立表现的患者可以在原来的中心安全地进行治疗，而无需转移到 I 级创伤中心。