ABSTRACT
Objective The study was to determine the relationship between acquired admission and/or pre-operative Rotterdam CT scores and TBI prognosis after standard decompressive craniectomy. Methods We chose 1 108 cases simple TBI patients with unilateral decompressive craniectomy(DC) from January 2011 to May 2016 in our hospital as the research object,and 212 patients which were reached standard were included in our retro-spective study. According to general data analysis,GOS 3 month after injury,the subject were divided into poor prognosis group and good prognosis group.Multiple factors logistic regression analysis was used to determine the re-lationship between acquired admission or preoperative Rotterdam CT scores and mortality or GOS in 3 month after injury. Results A total of 85 patients(40.1%) had a good prognosis and 127(59.9%) had a poor prognosis.A comparative analysis of different admission and preoperative Rotterdam CT scores groups showed the mortality and poor prognosis rates were statistically significant(P=0.00) in 4-6 groups of patients after injury 3 months.Multi-ple factors logistic regression analysis showed admission and preoperative Rotterdam CT scores were significantly as-sociated with mortality and poor prognosis(P<0.05).Conclusions Rotterdam CT scores provide important prog-nostic information of TBI patients with DC. Combined admission Rotterdam CT scores and preoperative Rotterdam CT scores may forecast the early mortality and long-term outcome for TBI patients.
ABSTRACT
Objective To analyze the relationship between the optic nerve sheath diameter (ONSD) and the scoring of Glasgow Coma Scale(GCS)or CT score(Rotterdam CT score or Helsinki CT score).Methods Sixty-three adult patients with traumatic brain injury in our emergency room were enrolled.All the patients were presented with the data of GCS and the classification of cranial CT,as well as ONSD measured by ultrasound.The correlation between ONSD and classification of cranial CT scores or GCS was analyzed by Spearman correlation analysis.Patients were divided into mild group,moderate group and severe group based on GCS or CT scores.One-way Analysis of Variance (ANOVA) was used to discover the difference in mean ONSD among different groups on account of scoring of GCS or cranial CT scores.The intergroup comparisons were analyzed by the least-significant-difference (LSD) tests.Results ONSD measurements were strongly correlated with GCS(r=-0.540,P＜0.01)or classification of Rotterdam CT scores (r=0.654,P＜0.01) and Helsinki CT scores (r=0.663,P＜0.01).The mean ONSD of the mild,moderate and severe group were (3.89±0.70)mm,(4.50±0.65)mm and (4.81±0.72) mm,respectively.The mean ONSD of the mild group was significantly shorter than that of severe group (P＜0.01) and moderate group(P＜0.05).The same results were found when comparing mean ONSDs among different groups classified by Rotterdam CT scores (low group (3.74±0.64)mm vs.middle group (4.3 l±0.73)mm vs.high group (5.09±0.57)mm,P＜0.01 or P＜0.05) or classified by Helsinki CT scores (low group (3.54±0.61)mm vs.middle group (4.46±0.73)mm vs.high group (5.16±0.37)mm,P＜0.01.Conclusions Ultrasonography used to measure ONSD is significantly correlated with both GCS and classification of head CT including Rotterdam CT score and Helsinki CT score.The results indicate that ultrasonography measurement of ONSD is helpful for early bedside assessment in patients with traumatic brain injury.
ABSTRACT
Objective To identify the factors enhancing the contusive brain hemorrhage following unilateral decompression craniectomy in patients with severe traumatic brain injury (TBI),and to explore the relationship between the initial Rotterdam CT score and clinical outcomes.Methods A prospective study of 291 consecutive patients with TBI admitted from Jan 2008 through Dec 2012 was carried out.Patients treated with unilateral decompression craniectomy were enrolled for study.Patients without preoperative or postoperative cranial CT imaging were excluded.Of them,235 patients were followed up.Gender,age,the causes of injury,preoperative general condition including Glasgow Coma Scale (GCS) score,pupillary response,laboratory data and the initial CT scans before operation,contusion hematoma size in CT scans following operation and Glasgow Outcome Scale (GOS) score were recorded.With t test,x2 test and nonparametric rank sum test,differences in the above listed variables were compared between patients with enlarged hematoma size group and those without change in hematoma size.A Classification And Regression Tree (CART) was used to predict the size of hematoma.Correlation analysis was used to find the relationship between the Rotterdam CT scores and GOS scores.Results The differences in age (t =2.034,P =0.043),first Rotterdam CT score (Z =4.838,P ＜ 0.01),GCS score (Z =4.440,P ＜ 0.01),pupillary response (Z =3.235,P =0.001),the length of time elapsed between the trauma occurred and the decompressive craniectomy (Z =3.874,P ＜ 0.01),glucose level (Z =3.880,P ＜ 0.01) and cerebrum hernia magnitude (Z =2.529,P =0.012) were significant between the patients with hematoma expanded (n =120) and those without change in hematoma size (n =115).The results of the CART indicated that Rotterdam score got from the initial head CT,glucose level and the length of time elapsed between trauma occurred and decompressive craniectomy were strong predictors of the risk for expanded hemorrhagic contusions following decompressive craniectomy.Both age and size of the removed bone-flap also could predict the risk of postoperative expansion of hemorrhagic contusions.The overall predictive accuracy of the CART model was 83.3％.Correlation analysis results indicated that Rotterdam CT score was negatively correlated with GOS (r =-0.333,P ＜ 0.01).Conclusions Initial Rotterdam CT scores,glucose level and the length of time between trauma and decompressive craniectomy may predict the risk of contusions expansion following decompressive craniectomy.Rotterdam CT score was negatively correlated with GOS.