Factors Affecting Surgical Outcome of Traumatic Brain Injury Patients
Keywords:
Favorable outcome, Unfavorable outcome, Traumatic Brain injury (TBI), Midline shiftAbstract
Traumatic brain injury (TBI) is the common cause of brain damage, resulting in death or long term-disability. Aim of this study was to identify factors affecting surgical outcome of traumatic brain injury patients. Eighty four patients was diagnosed with traumatic brain injury and was operated at Phra Nakhon Si Ayutthaya hospital from 1 June 2012-29 February 2015 and followed up for 6 months.
The results of study showed median age of patient was 34.5 years (4-77). Male:Female ratio was 6:1. Median Glasgow Coma Score (GCS) at admission was 9.0 (3-15). Good pupil reactivity was 50 case (59.5%). Median time from arrival hospital to operation was 4.0 hours (0.75-115). CT brain showed Acute subdural hematoma 24 cases (28.6%), Epidural hematoma 24 cases (28.6%), Multiple hemorrhage 31 cases (36.9%), Depress skull fracture 5 cases (6%). Mean midline shift was 0.79 cm. (0-1.8). The operation was Craniotomy 28 cases (33.3%) and Craniectomy 45 cases (53.6%). In-hospital mortality rate was 28.6%. Surgical outcome was evaluated at 6 months, dividing to favorable outcome (GOS4-5) and unfavorable outcome (GOS1-3). Patients with midline shift 5 mm. had significantly more favorable outcome (85.2% vs 40.4%) compared with those with midline shift >5 mm.
Conclusion: Midline shift 5 mm. is only factor that affecting favorable surgical outcome of Traumatic brain injury patients
References
2. Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LE, Gordon D Murray. Patient age and outcome following severe traumatic brain injury :
an analysis of 5600 patients. J Neurosurg 2003;99:666-673.
3. Tokutomi T, Miyagi T, Ogawa T, Ono J, Kawamata T, Sakamoto T, Minoru S. Ageassociated increase in poor outcomes after traumatic brain injury : a report from the Japan Neurotrauma Data Bank. J Neurotrauma 2008;25:1407-1414.
4. Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, Robert BS. Isolated traumatic brain injury : age is an Independent predictor of mortality and early outcome. J Trauma 2002;52:907-911.
5. Susman M, Dirusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, Adi H. Traumatic brain injury in the elderly : increase mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 2002;53:219-223.
6. Kentaro S, Takeshi M, Masahiro T, Atsuo Y, Yoichi K, M. Ross B. Outcome and Surgical Management for Geriatric Traumatic Brain Injury: Analysis of 888 Cases Registered in the Japan Neurotrauma Data Bank. World Neurosurgery 2014;82(6):1300-1306.
7. Jamjoom A, Nelson R, Stranjalis G, Wood S, Chissell H, Kane N, Cummins B. Outcome following surgical evacuation of traumatic intracranial hematomas in the elderly. Br J Neurosurg 1992;6:27-32.
8. Ross AM, Pitts LH, Kobayashi S. Prognosticators of outcome after major head Injury in the elderly. J Neurosci Nurs 1992;24:88-93.
9. Majdan Marek, Steyerberg Ewout W., Nieboer Daan, Mauritz Walter, Rusnak Martin, and Lingsma Hester F. Glasgow Coma Scale Motor Score and Pupillary Reaction To Predict Six-Month Mortality in Patients with Traumatic Brain Injury: Comparison of Field and Admission Assessment. J Neurotrauma 2015:32(2):101-108.
10. Limpastan K, Norasetthada T, Watcharasaksilp W, Vaniyapong T. Factors Influencing the Outcome of Decompressive Craniectomy Used in the Treatment of Severe Traumatic brain injury. Journal of the Medical Association of Thailand 2013;96(6):678-682.
11. Miller MT, Pasquale M, Kurek S, White J, Martin P, Bannon K, Wasser T. et al. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 2004;56(5):967-972.
12. Lobato RD, Alen JF, Perez-Nunez A, Alday R, Gomez PA, Pascual B, Lagares A., et al. Value of serial CT scanning and intracranial pressure monitoring for detecting new intracranial mass effect in severe head injury patients showing lesion type I-II in the initial CT scan. Neurocirugia (Astur) 2005;16(3):217-234.
13. Marmarou A, Anderson R, Ward J, Choi S. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75(Suppl):S159-S166.
14. Braton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT., et al. Guidelines for the management of severe traumatic brain injury. XIV. Hyperventilation. J Neurotrauma 2007;24 Suppl 1:S87-90.
15. Braton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT., et al. Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma 2007;24 Suppl 1:S14-20.
Downloads
Published
How to Cite
Issue
Section
License
บทความที่ลงพิมพ์ในวารสารเวชศาสตร์ป้องกันแห่งประเทศไทย ถือเป็นผลงานวิชาการ งานวิจัย วิเคราะห์ วิจารณ์ เป็นความเห็นส่วนตัวของผู้นิพนธ์ กองบรรณาธิการไม่จำเป็นต้องเห็นด้วยเสมอไปและผู้นิพนธ์จะต้องรับผิดชอบต่อบทความของตนเอง
