Retrospective study on neurological deterioration after mild traumatic brain injury
10.3760/cma.j.jssn.1673-4904.2016.09.017
- VernacularTitle:轻型颅脑创伤患者病情加重的回顾性研究
- Author:
Jianqiang XU
;
Xin HUANG
;
Yongdong SUN
;
Li SUN
- Publication Type:Journal Article
- Keywords:
Mild traumatic brain injury;
Disease progression;
Factor analysis,statistical;
Treatment outcome
- From:
Chinese Journal of Postgraduates of Medicine
2016;39(9):822-825
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the causes, temporal courses, predictors and outcomes of delayed neurological deterioration (DND) after mild traumatic brain injury. Methods In a cohort of 254 patients, the incidence, causes and temporal courses of DND after mild traumatic brain injury were summed up. Univariate and multivariate (Logistic regression) analysis were performed to assess the predictors of DND. The short-term outcomes were compared between patients with and without DND. Results DND occurred in 14.2% (36/254) of the 254 patients. Intracranial causes of DND such as hematoma growth were observed in 91.7%(33/36) of patients with DND. The interval from arrival to DND was 0.5- 59.0 h. Thirty patients (83.3%, 30/36) deteriorated within 24 h. The univariate analysis revealed that dangerous injury mechanism, loss of consciousness, severe headache, more than 1 time vomiting, interval from injury to first CT scanning, first Glasgow coma scale (GCS) scores, basal skull fracture, hypocoagulability, heavy alcohol consumption were the predict factors for DND (P<0.05 or<0.01). The multivariate analysis revealed that interval from injury to first CT scanning (P=0.000, OR=0.169, 95% CI: 0.083- 0.344), first GCS scores (P = 0.004, OR = 0.355, 95%CI: 0.175- 0.721) and hypocoagulability (P=0.001, OR=0.077, 95%CI:0.017-0.354) were the independent predict factors for DND. All of the patients without DND recovered better. But in the patients with DND, 30 patients recovered better, 4 patients had slight disability, 1 patient had severe disability, and 1 patient died. The treatment outcome between two groups had significant difference (Z =-6.088, P = 0.000). Conclusions The causes of DND are mostly intracranial. Most patients deteriorat within 24 h. The interval from injury to first CT scanning, first GCS scores and hypocoagulability appear to be independent predictors of DND. DND is associated with poor short-term outcomes.
