Journal of Trauma-Injury Infection and Critical Care最新文献

{"title":"Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock.","authors":"Gordon M Riha,&nbsp;Nicholas R Kunio,&nbsp;Philbert Y Van,&nbsp;Gregory J Hamilton,&nbsp;Ross Anderson,&nbsp;Jerome A Differding,&nbsp;Martin A Schreiber","doi":"10.1097/TA.0b013e3182367b1c","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182367b1c","url":null,"abstract":"<p><strong>Background: </strong>The optimal fluid strategy for the early treatment of trauma patients remains highly debated. Our objective was to determine the efficacy of an initial bolus of resuscitative fluids used in military and civilian settings on the physiologic response to uncontrolled hemorrhagic shock in a prospective, randomized, blinded animal study.</p><p><strong>Methods: </strong>Fifty anesthetized swine underwent central venous and arterial catheterization followed by celiotomy. Grade V liver injury was performed, followed by 30 minutes of uncontrolled hemorrhage. Then, liver packing was completed, and fluid resuscitation was initiated over 12 minutes with 2 L normal saline (NS), 2 L Lactated Ringer's (LR), 250 mL 7.5% hypertonic saline with 3% Dextran (HTS), 500 mL Hextend (HEX), or no fluid (NF). Animals were monitored for 2 hours postinjury. Blood loss after initial hemorrhage, mean arterial pressure (MAP), tissue oxygen saturation (StO2), hematocrit, pH, base excess, and lactate were measured at baseline, 1 hour, and 2 hours.</p><p><strong>Results: </strong>NF group had less post-treatment blood loss compared with other groups. MAP and StO2 for HEX, HTS, and LR at 1 hour and 2 hours were similar and higher than NF. MAP and StO2 did not differ between NS and NF, but NS resulted in decreased pH and base excess.</p><p><strong>Conclusions: </strong>Withholding resuscitative fluid results in the least amount of posttreatment blood loss. In clinically used volumes, HEX and HTS are equivalent to LR with regard to physiologic outcomes and superior to NF. NS did not provide a measurable improvement in outcome compared with NF and resulted in increased acidosis.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1755-60"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182367b1c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term comparison of a routine laboratory parameter-based severity score with APACHE II and SAPS II.","authors":"Ole Goertz,&nbsp;Amir F Gharagozlou,&nbsp;Tobias Hirsch,&nbsp;Heinz H Homann,&nbsp;Hans U Steinau,&nbsp;Adrien Daigeler,&nbsp;Reiner Kempf,&nbsp;Axel Stachon","doi":"10.1097/TA.0b013e3182154f0b","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182154f0b","url":null,"abstract":"<p><strong>Background: </strong>Risk score models predicting mortality have tremendous value, but because of the additional effort involved, their clinical use remains low. The aim of this study is to compare three different scores that each requires different levels of effort during admission and throughout treatment: the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiology Score II (SAPS II), and the Dense Laboratory Whole Blood Applied Risk Estimation (DELAWARE) score. Of the three, only the DELAWARE is based solely on routine laboratory parameters.</p><p><strong>Methods: </strong>Prospective data of the three scores were collected for 268 surgical patients admitted to the intensive care unit over 1 year. The predicted hospital mortality and survival were evaluated for the first 14 days.</p><p><strong>Results: </strong>With a cutoff value of 0.65, the sensitivity of the DELAWARE was 71.6%, the specificity, 92.5%, and the correct classification rate, 87.3%. The APACHE II and SAPS II showed values of 41.2%/96.8%/86.2% and 62.7%/87.1%/82.5%, respectively. The r2 value was 0.884 for the DELAWARE, 0.876/0.814 for the APACHE II and SAPS II. Hospital mortality rate was overestimated by 20% to 65% in all scores. The discriminatory ability of the APACHE II and SAPS II increased throughout the course of treatment.</p><p><strong>Conclusions: </strong>The routine laboratory-based DELAWARE provides a reliable, valid risk assessment of the surgical intensive care patient at admission. It also provides additional information without added effort or poor interobserver reliability, which leads to better data comparability. We have to state that until now the data have been collected in a single-center and their general validity is therefore limited. By the end of treatment, the SAPS II and APACHE II had increased discriminatory ability and are therefore useful as process parameters.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1835-40"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182154f0b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29852914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter to the Editor “Most Suitable Modality to Assess the IVC in the Trauma Patient”","authors":"Yu-Ying Liao, K. Chen","doi":"10.1097/TA.0B013E31823F3DC5","DOIUrl":"https://doi.org/10.1097/TA.0B013E31823F3DC5","url":null,"abstract":"","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"5 1","pages":"1925"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75362824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture--update and systematic review.","authors":"Daniel C Cullinane, Henry J Schiller, Martin D Zielinski, Jaroslaw W Bilaniuk, Bryan R Collier, John Como, Michelle Holevar, Enrique A Sabater, S Andrew Sems, W Matthew Vassy, Julie L Wynne","doi":"10.1097/TA.0b013e31823dca9a","DOIUrl":"10.1097/TA.0b013e31823dca9a","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice.</p><p><strong>Methods: </strong>Building on the previous systematic literature review in the 2001 EAST guidelines, a systematic literature review was performed to include references from 1999 to 2010. Prospective and retrospective studies were included. Reviews and case reports were excluded. Of the 1,432 articles identified, 50 were selected as meeting criteria. Nine Trauma Surgeons, an Interventional Radiologist, and an Orthopedic Surgeon reviewed the articles. The EAST primer was used to grade the evidence.</p><p><strong>Results: </strong>Six questions regarding hemorrhage from pelvic fracture were addressed: (1) Which patients with hemodynamically unstable pelvic fractures warrant early external mechanical stabilization? (2) Which patients require emergent angiography? (3) What is the best test to exclude extrapelvic bleeding? (4) Are there radiologic findings which predict hemorrhage? (5) What is the role of noninvasive temporary external fixation devices? and (6) Which patients warrant preperitoneal packing?</p><p><strong>Conclusions: </strong>Hemorrhage due to pelvic fracture remains a major cause of morbidity and mortality in the trauma patient. Strong recommendations were made regarding questions 1 to 4. Further study is needed to answer questions 5 and 6.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1850-68"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental findings in focused assessment with sonography for trauma in hemodynamically stable blunt trauma patients: speaking about cost to benefit.","authors":"George Sgourakis,&nbsp;Sophocles Lanitis,&nbsp;Maria Korontzi,&nbsp;Christos Kontovounisios,&nbsp;Constantine Zacharioudakis,&nbsp;Vasilios Armoutidis,&nbsp;Charilaos Karaliotas,&nbsp;Georgia Dedemadi,&nbsp;Nicki Lepida,&nbsp;Constantine Karaliotas","doi":"10.1097/TA.0b013e3182249eaa","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182249eaa","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to identify which age-related groups of hemodynamically stable blunt trauma patients will present a positive cost-to-benefit ratio, in regard to the screening of incidental findings on Focused Assessment with Sonography for Trauma (FAST).</p><p><strong>Methods: </strong>We conducted a prospective study using retrospective data taken from the trauma registry of 6,041 consecutive hemodynamically stable blunt trauma patients who underwent FAST at our Level I urban trauma hospital during the year 2009. A receiver operating characteristic curve was used to determine whether age level is useful in detecting organ-/system-specific incidental findings in trauma patients undergoing FAST and to establish the required diagnostic cutoff value of this selected test. A cost-benefit analysis was then performed for the age-specific cutoff values of each organ/system evaluated by FAST.</p><p><strong>Results: </strong>We found 522 incidental findings in 468 patients (7.8%). Further diagnostic workup was instructed in 35% (168 of 468) of patients with incidental findings. The cost-benefit analysis for the age-specific cutoff values found in the receiver operating characteristic curve analysis showed that the project of screening for incidental findings on FAST was viable only when the ultrasound operator additionally searches the liver/biliary tree (≥43 years) and the kidneys (≥56 years).</p><p><strong>Conclusions: </strong>A systematic examination of the liver and biliary tree and both kidneys of specific age groups during FAST screening of hemodynamically stable blunt trauma patients may disclose a potentially unknown pathology with a positive cost-to-benefit ratio.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"E123-7"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182249eaa","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial odds for amputation ratio in traumatic lower extremity fractures.","authors":"Daniel J Weber,&nbsp;David A Shoham,&nbsp;Amy Luke,&nbsp;R Lawrence Reed,&nbsp;Fred A Luchette","doi":"10.1097/TA.0b013e31823c5f94","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823c5f94","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have demonstrated that black patients receive substandard care compared with white patients across healthcare settings. The purpose of this study was to evaluate the association of race on the management (salvage vs. amputation) of traumatic lower extremity open fractures.</p><p><strong>Methods: </strong>Data analysis was conducted using the American College of Surgeon's National Trauma Data Bank. Open tibial and fibular (OTFF) and open femoral (OFF) fractures among adults above the age of 18 were identified by International Classification of Diseases, 9th Revision codes. Injuries were identified as amputated based on the presence of one of three types of knee amputations. Statistical analysis included logistic regression stratified for sex, age, race, mechanism of injury, severity, and insurance type.</p><p><strong>Results: </strong>From the National Trauma Data Bank, 10,082 OFF and 22,479 OTFF were identified. Amputation rates were 3.1% for OFF and 4.2% for OTFF. With age stratification, the ratio of amputation odds for blacks to amputation odds for whites (i.e., the Racial Odds for Amputation Ratio [ROAR]) demonstrated a significant interaction between black and age in both the OFF (p = 0.028) and OTFF (p = 0.008) groups. In younger patients, a lower ROAR (p = 0.016) favored salvage in blacks, while the ROAR in older patients favored amputation in blacks (p = 0.013). The higher prevalence of penetrating injuries in blacks only accounted for 12.7% of the lower ROAR among younger adults.</p><p><strong>Conclusions: </strong>There exists a racial disparity in the management of lower extremity open fractures. Older blacks have greater odds of amputation that is not explained by mechanism. In contrast, younger blacks have lower odds for amputation that is only partially explained by mechanism of injury.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1732-6"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823c5f94","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic brain injury and posttraumatic stress disorder: overlap in underlying substrates.","authors":"Delphine Le Moullec,&nbsp;Alexandre Salvadori,&nbsp;Pascal Constantin,&nbsp;Jean-Pierre Tourtier","doi":"10.1097/TA.0b013e31823a52cc","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823a52cc","url":null,"abstract":"To the Editor: We read with interest the article titled “Routine Follow-Up Imaging of Kidney Injuries May Not Be Justified” written by Bukur et al. and wish to comment respectfully on the use of nephrectomy verses renorrhaphy in this interesting report. In this series, there seems to be a 100% nephrectomy rate in patients with blunt trauma who underwent operative management. This included 5 out of 5 patients with highgrade injury and the only patient with low-grade blunt trauma who underwent surgery.1 This is interesting in the light of an overall greater tendency toward renal repair rather than removal in academic centers.2 In their series of 94 patients with grade III-IV blunt renal injury, Shirazi et al. had a 41% rate of operative management, 31 cases (75%) of which underwent nephrorrhaphy. This higher rate of renal repair can however partly be explained by lower overall grade of injury in this series.3 In addition, no comment was made about whether gunshot wounds were also included in the series. In our opinion, the 21% nephrectomy rate in grade I-III renal injuries was suggestive of possible presence of gunshot wounds. As a conclusion, although the overall trend is obviously toward less invasive measures,4 the mentioned comparison seems to support institutional tendencies toward various management protocols in this ever-evolving topic, a fact pointing to a need for further standardization.","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1923-4; author reply 1924"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823a52cc","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological, functional, and biomechanical characteristics after high-velocity behind armor blunt trauma of the spine.","authors":"Bo Zhang,&nbsp;Yifeng Huang,&nbsp;Zhenglin Su,&nbsp;Shuangping Wang,&nbsp;Shu Wang,&nbsp;Jianmin Wang,&nbsp;Aimin Wang,&nbsp;Xinan Lai","doi":"10.1097/TA.0b013e318231bce7","DOIUrl":"https://doi.org/10.1097/TA.0b013e318231bce7","url":null,"abstract":"<p><strong>Background: </strong>Behind armor blunt trauma (BABT) describes a nonpenetrating injury to the organs of an individual wearing body armor. The aim of this study was to investigate the neurologic and functional changes that occur in the central nervous system after high-velocity BABT of the spine as well as its biomechanical characteristics.</p><p><strong>Methods: </strong>This study evaluated 28 healthy adult white pigs. Animals were randomly divided into three experimental groups: (1) 15 animals (9 in the exposed group and 6 in the control group) were tested for neurologic changes; (2) 10 animals (5 in the exposed group and 5 in the control group) were used for studies of cognitive function; (3) and 3 animals were used for examination of biomechanics. In the group tested for neurologic changes, 9 anesthetized pigs wearing body armor (including a ceramic plate and polyethylene body armor) on the back were shot on the eighth thoracic vertebrae (T8) with a 5.56-mm rifle bullet (velocity appropriately 910 m/s). As a control, six pigs were shot with blank ammunition. Ultrastructural changes of the spinal cord and brain tissue were observed with light and electron microscopy. Expression levels of myelin basic protein, neuron-specific enolase (NSE), and glial cytoplasmic protein (S-100B) were investigated in the serum and cerebrospinal fluid using enzyme-linked immunosorbent assays. Electroencephalograms (EEGs) were monitored before and 10 minutes after the shot. Pressures in the spine, common carotid artery, and brain were detected. Acceleration of the 10th vertebrae (T10) was tested. Finally, cognitive outcomes between exposed and control groups were compared.</p><p><strong>Results: </strong>Neuronal degeneration and nerve fiber demyelination were seen in the spinal cord. The concentrations of neuron-specific enolase, myelin basic protein, and S-100B were significantly increased in the serum and cerebrospinal fluid 3 hours after trauma (p < 0.05). The electroencephalogram was suppressed within 3 to 6 minutes after trauma. The pressure detected in the brain was higher than that detected in the common carotid artery (p < 0.01). The trauma resulted in paralysis of two hind limbs and in cognitive dysfunction.</p><p><strong>Conclusion: </strong>The results from our animal model indicate that high-velocity BABT of the spine generates high pressure and acceleration in the spine, induces varying degrees of paralysis of hind limbs, and disturbs cerebral function. The neuronal degeneration caused by the pressure wave may be one of the important pathologic events involved in the development of trauma-related complications.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1680-8"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e318231bce7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients.","authors":"Hsin Lin,&nbsp;Iris Faraklas,&nbsp;Jeffrey Saffle,&nbsp;Amalia Cochran","doi":"10.1097/TA.0b013e31823070f9","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823070f9","url":null,"abstract":"<p><strong>Background: </strong>Inadequate antifactor Xa levels have been documented in critically ill patients given prophylactic enoxaparin and may result in increased risk of venous thromboembolic (VTE) events. The objective of this study was to examine the impact of dose adjustment of enoxaparin and associated incidence of VTE in acute burn patients.</p><p><strong>Methods: </strong>All acute burn patients who were treated with prophylactic enoxaparin on a burn/trauma intensive care unit were prospectively followed. Patients with subtherapeutic antifactor Xa levels had enoxaparin doses increased as per unit protocol with the goal of obtaining a therapeutic antifactor Xa level.</p><p><strong>Results: </strong>Eighty-four acute burn patients who were treated with enoxaparin had at least one appropriately obtained antifactor Xa level between June 2009 and October 2010. Initial antifactor Xa levels in 64 patients (76.2%) were below 0.2 U/mL, resulting in increased enoxaparin dose. Fifteen patients never achieved the target antifactor Xa level before enoxaparin was discontinued. Median final enoxaparin dose required to achieve therapeutic antifactor Xa levels was 40 mg every 12 hours (range, 20-70 mg). Using linear regression, final enoxaparin dose correlated with burn size (%total body surface area) and weight. No episodes of hemorrhage, thrombocytopenia, or heparin sensitivity were documented. Two patients (2.4%) had VTE complications despite adequate prophylaxis.</p><p><strong>Conclusions: </strong>Frequent occurrence of low antifactor Xa levels observed in this study demonstrated the inadequacy of standard dosing of enoxaparin for VTE prophylaxis in many patients with acute burns. Enoxaparin dose adjustment was associated with a low incidence of VTE events and no bleeding complications.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1557-61"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823070f9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30088405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma.","authors":"Shih-Han Chen,&nbsp;Yun Chen,&nbsp;Wen-Kuei Fang,&nbsp;Da-Wei Huang,&nbsp;Kuo-Chang Huang,&nbsp;Sheng-Hong Tseng","doi":"10.1097/TA.0b013e3182367b3c","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182367b3c","url":null,"abstract":"<p><strong>Background: </strong>Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with acute SDH and low Glasgow Coma Scale (GCS) score treated with craniotomy or DC.</p><p><strong>Methods: </strong>We analyzed 102 patients with acute SDH and GCS scores of 4 to 8. Of them, 42 patients (41.2%) were treated with craniotomy and 60 (58.8%) treated with DC for evacuation of hematoma. The demographic and clinical data were analyzed including patient age, sex, injury mechanism, GCS score, pupil size and light reflex, time interval from injury to operation, types of surgical procedures, intracranial findings in pre- and postoperative computed tomography scan, intracranial pressure, complications, requirement of permanent cerebrospinal fluid diversion, and Glasgow Outcome Scale score after at least 1 year of follow-up.</p><p><strong>Results: </strong>The craniotomy and DC groups showed no difference in the demographic and clinical data. There was no difference in the outcomes and complication rates between these two groups except that the DC group had higher mortality than the craniotomy group (23.3% vs. 7.1%, p = 0.04).</p><p><strong>Conclusion: </strong>Both craniotomy and DC were feasible treatment strategies for acute SDH. The patients with acute SDH and low GCS score treated with craniotomy or DC showed no difference in the outcomes and complications.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":"71 6","pages":"1632-6"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182367b3c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30088406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}