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Chien SC, Tu PH, Liu ZH, Chen CC, Liao CH, Hsieh CH, Fu CY. Neurological deteriorations in mild brain injuries: the strategy of evaluation and management. Eur J Trauma Emerg Surg 2021; 48:2173-2181. [PMID: 34302502 DOI: 10.1007/s00068-021-01753-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Most mild traumatic brain injuries (TBIs) can be treated conservatively. However, some patients deteriorate during observation. Therefore, we tried to evaluate the characteristics of deterioration and requirement for further management in mild TBI patients. METHODS From 1/1/2017 to 12/31/2017, patients with mild TBI and positive results on CT scans of the brain were retrospectively studied. Patients with and without neurological deteriorations were compared. The characteristics of mild TBI patients with further neurological deterioration or the requirement for interventions were delineated. RESULTS One hundred ninety-two patients were enrolled. Twenty-three (12.0%) had neurological deteriorations. The proportions of deterioration occurring within 24 h, 48 h and 72 h were 23.5, 41.2 and 58%, respectively. Deteriorated patients were significantly older than those without neurological deteriorations (69.7 vs. 60.2; p = 0.020). More associated extracranial injuries were observed in deteriorated patients [injury severity score (ISS): 20.2 vs. 15.9; p = 0.005). Significantly higher proportions of intraventricular hemorrhage (8.7 vs. 1.2%; p = 0.018) and multiple lesions (78.3 vs. 53.8%; p = 0.027) were observed on the CT scans of patients with neurological deteriorations. Subset analysis showed that deteriorated patients who required neurosurgical interventions (N = 7) had significantly more initial GCS defects (13 or 14) (71.4 vs. 12.5%; p = 0.005) and more initial decreased muscle power of extremities (85.7 vs. 18.8%; p = 0.002). CONCLUSION More attention should be given to mild TBI patients with older age, GCS defects, decreased muscle power of the extremities, multiple lesions on CT scans and other systemic injuries (high ISS). Most deteriorations occur within 72 h after trauma.
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Affiliation(s)
- Shou-Chi Chien
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan.
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