Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study

Ernest J. Bobeff; Bartłomiej J. Posmyk; Katarzyna Ł. Bobeff; Jan Fortuniak; Karol Wiśniewski; Konrad Stawiski; Ludomir Stefańczyk; Dariusz J. Jaskólski

doi:10.1055/s-0039-1692672

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg 2019; 80(06): 460-469
DOI: 10.1055/s-0039-1692672

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study

Ernest J. Bobeff

¹Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

,

Bartłomiej J. Posmyk

¹Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

,

Katarzyna Ł. Bobeff

²Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Konopnicka Memorial Teaching Hospital, Sporna, Lodz, Poland

,

Jan Fortuniak

¹Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

,

Karol Wiśniewski

¹Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

,

Konrad Stawiski

³Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka, Lodz, Poland

,

Ludomir Stefańczyk

⁴Department of Radiology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

,

Dariusz J. Jaskólski

¹Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland

› Institutsangaben

Abstract

Objective Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide. The prognostic value of skull fracture (SF) remains to be clearly defined. To evaluate the need for neurosurgical intervention and determine the risk factors of conservative treatment failure (CTF), we retrieved from the hospital database the records of patients with SF after TBI.

Methods We analyzed 146 consecutive patients (mean age: 49.8 ± 17.5 years) treated at the department of neurosurgery in a 5-year period. Clinical data, radiologic reports, and laboratory results were evaluated retrospectively.

Results A total of 63% of patients were treated conservatively, 21.9% were operated on immediately, and 15.1% experienced CTF. Overall, 73.3% had a favorable outcome; the mortality rate was 13%. Intracranial bleeding occurred in 96.6% of cases, basilar SF in 61%, and cerebrospinal fluid (CSF) leak in 2.8%. The independent risk factors for outcome were Glasgow Coma Scale (GCS) score, age, and platelet count (PCT). The independent risk factors for CTF were epidural hematoma, subdural hematoma, mass effect, edema, international normalized ratio, PCT, mean platelet volume, and CSF leakage. The consensus decision tree algorithm used at the accident and emergency department indicated patients with no need for neurosurgical intervention with an accuracy of 91.7%, sensitivity of 88.9%, and featured the importance of mass effect, GCS, and epidural hematoma.

Conclusions Tests included in the complete blood count appeared useful for predicting the course in patients with SF, although the most important factors were age and neurologic status, as well as radiologic findings. Our decision tree requires further validation before it can be used in everyday practice.

Keywords

skull fracture - outcome - conservative treatment failure - decision tree

Volltext

Referenzen

References
1 Dewan MC, Rattani A, Gupta S. , et al. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018 ; April 1 (Epub ahead of print)
2 Maas AIR, Menon DK, Adelson PD. , et al; InTBIR Participants and Investigators. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16 (12) 987-1048
3 Meaney DF, Morrison B, Dale Bass C. The mechanics of traumatic brain injury: a review of what we know and what we need to know for reducing its societal burden. J Biomech Eng 2014; 136 (02) 021008
4 Hardman JM, Manoukian A. Pathology of head trauma. Neuroimaging Clin N Am 2002; 12 (02) 175-187 , vii
5 Reilly PL, Graham DI, Adams JH, Jennett B. Patients with head injury who talk and die. Lancet 1975; 2 (7931): 375-377
6 Shibahashi K, Sugiyama K, Okura Y, Hoda H, Hamabe Y. A multicenter retrospective cohort study of ”talk and die” after traumatic brain injury. World Neurosurg 2017; 107: 82-86
7 Greenberg MS. Handbook of Neurosurgery. 8th ed. New York, NY: Thieme; 2016: 384-393
8 Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 2015; (04) CD004884
9 Bullock MR, Chesnut R, Ghajar J. , et al. Surgical management of traumatic brain injury author group: surgical management of acute subdural hematomas. Neurosurgery 2006; 58: S16-S24 ; discussion Si–Siv
10 Macpherson BCM, MacPherson P, Jennett B. CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture. Clin Radiol 1990; 42 (05) 321-326
11 Stephens JR, Holmes S, Evans BT. Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?. Int J Oral Maxillofac Surg 2016; 45 (03) 275-278
12 Bajsarowicz P, Prakash I, Lamoureux J. , et al. Nonsurgical acute traumatic subdural hematoma: what is the risk?. J Neurosurg 2015; 123 (05) 1176-1183
13 Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien) 1993; 121 (3–4): 100-108
14 Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK. Natural course of initially non-operated cases of acute subdural hematoma : the risk factors of hematoma progression. J Korean Neurosurg Soc 2013; 54 (03) 211-219
15 Yuan F, Ding J, Chen H. , et al. Predicting progressive hemorrhagic injury after traumatic brain injury: derivation and validation of a risk score based on admission characteristics. J Neurotrauma 2012; 29 (12) 2137-2142
16 Brawley BW, Kelly WA. Treatment of basal skull fractures with and without cerebrospinal fluid fistulae. J Neurosurg 1967; 26 (01) 57-61
17 Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg 2001; 25 (08) 1062-1066
18 Yellinek S, Cohen A, Merkin V, Shelef I, Benifla M. Clinical significance of skull base fracture in patients after traumatic brain injury. J Clin Neurosci 2016; 25: 111-115
19 Patel KV, Semba RD, Ferrucci L. , et al. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci 2010; 65 (03) 258-265
20 Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009; 169 (06) 588-594
21 Ji HM, Han J, Bae HW, Won YY. Combination of measures of handgrip strength and red cell distribution width can predict in-hospital complications better than the ASA grade after hip fracture surgery in the elderly. BMC Musculoskelet Disord 2017; 18 (01) 375
22 Havens JM, Seshadri AJ, Salim A, Christopher KB. Red cell distribution width predicts out of hospital outcomes in critically ill emergency general surgery patients. Trauma Surg Acute Care Open 2018; 3 (01) e000147
23 Kim SH, Yeon JH, Park KN. , et al. The association of red cell distribution width and in-hospital mortality in older adults admitted to the emergency department. Scand J Trauma Resusc Emerg Med 2016; 24: 81
24 Kong T, Park JE, Park YS. , et al. Usefulness of serial measurement of the red blood cell distribution width to predict 28-day mortality in patients with trauma. Am J Emerg Med 2017; 35 (12) 1819-1827
25 Liu ZH, Hu H. The RTS plus measurement of the RDW improves the prediction of 28-day mortality in trauma patients. Am J Emerg Med 2018; 36 (06) 1112-1113
26 Lv H, Zhang L, Long A. , et al. Red cell distribution width as an independent predictor of long-term mortality in hip fracture patients: a prospective cohort study. J Bone Miner Res 2016; 31 (01) 223-233
27 Majercik S, Fox J, Knight S, Horne BD. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg 2013; 74 (04) 1021-1026
28 Wernick B, Cipriano A, Odom SR. , et al. Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma. Eur J Trauma Emerg Surg 2017; 43 (03) 399-409
29 Yin P, Lv H, Zhang L, Long A, Zhang L, Tang P. Combination of red cell distribution width and American Society of Anesthesiologists score for hip fracture mortality prediction. Osteoporos Int 2016; 27 (06) 2077-2087
30 Zehir S, Sipahioğlu S, Ozdemir G, Sahin E, Yar U, Akgül T. Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis. Acta Orthop Traumatol Turc 2014; 48 (02) 141-146
31 Lippi G, Bovo C, Buonocore R, Mitaritonno M, Cervellin G. Red blood cell distribution width in patients with limb, chest and head trauma. Arch Med Sci 2017; 13 (03) 606-611
32 Cherian I, Yi G, Munakomi S. Cisternostomy: replacing the age old decompressive hemicraniectomy?. Asian J Neurosurg 2013; 8 (03) 132-138
33 Giammattei L, Messerer M, Oddo M, Borsotti F, Levivier M, Daniel RT. Cisternostomy for refractory posttraumatic intracranial hypertension. World Neurosurg 2018; 109: 460-463
34 Iliff JJ, Wang M, Liao Y. , et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β. Sci Transl Med 2012; 4 (147) 147ra111
35 Salottolo K, Carrick M, Stewart Levy A, Morgan BC, Slone DS, Bar-Or D. The epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3. J Crit Care 2017; 38: 197-201