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KMID : 1141120180040020060
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The Nerve
2018 Volume.4 No. 2 p.60 ~ p.66
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Progressive Neurological Deterioration in Mild Traumatic Brain Injury with Acute Intracranial Hemorrhage: A Single Center, Retrospective Observational Comparative Study
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Kim Jung-Hoon
Park Jae-Sung
Son Byung-Chul
Jeon Sin-Soo
Lee Kwan-Sung
Shin Yong-Sam
Choi Jin-Gyu
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Abstract
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Objective: To assess the rate of acute neurologic aggravation of mild traumatic brain injury (TBI) patients, and to compare the deterioration frequency between categorized admission characteristic groups and the mean values between deteriorated and non-deteriorated groups.
Method: From Jan. 2014 to Aug. 2017, medical records of mild TBI patients (Glasgow Coma Scale ≥13 on arrival) were retrospectively reviewed. Admission characteristics and neurologic outcome of the first treatment week were analyzed. We compared the frequency of progressive deteriorated patients between independent variable groups and also mean value of admission characteristics between deteriorated and non-deteriorated groups.
Results: The 193 patients were included in this study. 22 showed neurologic aggravation in the first treatment week. Subdural hematoma (SDH; n=82, 42.5%) was the most frequent CT finding as main lesion. The thickness of epidural hematoma (EDH) or SDH, midline shift and compression of basal cistern in the initial CT scan were significant factors of progressive deterioration, whereas the volume of intracranial hemorrhage (ICH) showed no significance. In laboratory tests, deteriorated group had low hemoglobin (Hb) level and higher white blood cell count. However, the initial vital signs didn't significantly affect the outcome.
Conclusion: In this study, thickness of EDH or SDH in the initial CT scan, coagulopathy, leukocytosis, anemia showed to have effect on neurologic aggravation. Systolic blood pressure and body temperature, which have been considered important in managing severe TBI patients, showed no significance. However, because the difference is not large enough for clinical use, further studies are needed for verification.
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KEYWORD
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Brain injuries, traumatic, Clinical laboratory techniques, Intracranial hemorrhages, Prognosis
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