| Abstract |
BACKGROUND
In the Western world Traumatic Brain Injury is one of the main causes of death and disability after trauma in young patients under the age of 45. TBI is defined as a “change in cerebral function or the presence of evidence of brain pathology caused by external force." The therapeutic approach should aim to minimize secondary injury that can be potentially prevented or reduced. Conservative treatment is based on brain protection measures and intracranial pressure control measures. Surgery is dependent on the imaging findings of CT or after worsening of the clinical picture of the patient. The existence of prognostic models based on clinical and neuro imaging criteria is crucial for the risk stratification of patients and for choosing an appropriate therapeutic approach.
OBJECTIVES
The purpose of this study was the collection and recording of data concerning the total number of patients with traumatic brain injury admitted at the University Hospital of Heraklion as well as the correlation of the clinical and imaging characteristics of the patients upon their admission to the hospital and the treatment followed to the outcome.
METHOLOGY
This is a retrospective study of data collection concerning the epidemiological characteristics (gender, age, mechanism of injury), the neurological assessment (entry and discharge GCS), the CT Rotterdam assessment of the CT, the treatment strategy and the outcome of the patients hospitalized in the University Hospital of Heraklion in the period 1/1/2013 to 31/12/2017, according to ICD-10 diagnosis ,traumatic brain injury (S06). Moreover the correlation of the above variables with the final outcome as prognostic markers was studied.
RESULTS
In total of the 431 patients, men were the majority corresponding to 71.5% of total patients (308 patients). Road accidents were the main cause of TBI injuries ( 34.1%) followed by falls (24.7%) and same height falls (20%). As for age, children (0-14) were 119 (27.6%), adults 312 (72.3%).
Twenty two percent of all patients underwent surgery either directly or after failure of conservative measures whereas the majority of patients (77.7%)) were treated conservatively. 41 patients died during their hospitalization (9.5%). The mortality rate of patients with severe TBI was 23%. Finally, the statistical analysis of the variables showed that patients > 40 years had 97.6% less chance of survival than patients ≤ 40 years. While a GCS increase of 1 leads to a 1.5-fold increase in survival, and CT Rotterdam> 3 patients have a 93.7% lower chance of survival than Rotterdam CT ≤3 patients.
CONCLUSION
Male predominance in all TBI patients is particularly pronounced at the age of less than 40 years where traffic is the main cause of injuries. Falls were the dominate cause at ages> 60 years. Mortality in all TBI patients was approximately 10% while in patients with severe injury it was 77%. Surgery was more often at older ages> 60 years, at patients with low GCS score, at patients with Rotterdam rating> 3 and was associated with worse outcome. Low GCS value, age> 40 years, Rotterdam rating> 3 were identified as prognostic predictors of worse outcome of TBI patients.
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Θεραπευτική προσέγγιση και έκβαση ασθενών με κρανιοεγκεφαλική κάκωση (Κ.Ε.Κ.) στο πανεπιστημιακό γενικό νοσοκομείο Ηρακλείου
