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创伤性脑下血瘤的手术神经外科手术:创伤中心变异与患者结果之间的关联
Vikas N Vattipally1, Kathleen R Ran1, Debraj Mukherjee1
11Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore.
Journal of neurosurgery
|July 25, 2025
概括
创伤性脑下血液瘤 (SDH) 的手术干预在创伤中心之间有很大差异. 具有较高外科手术率的中心显示出更好的患者结果,包括降低死亡率和改善出院处置.
科学领域:
- 神经外科 神经外科
- 创伤护理 创伤护理
- 脑损伤研究 脑损伤研究
背景情况:
- 创伤性脑下血瘤 (SDH) 是一种严重的创伤性脑损伤 (TBI),需要迅速进行神经外科干预.
- 准则建议对SDH进行外科疏散,中线偏移>5毫米,但实际实践模式尚不清楚.
研究的目的:
- 在创伤中心 (TC) 之间调查创伤性SDH手术干预率的变化.
- 确定SDH手术干预中的TC水平变化是否会影响患者死亡率和出院结果.
主要方法:
- 在454个美国TC (2017-2019) 中,对13087名患有严重TBI和SDH (MLS>5毫米) 的成年患者进行了回顾性队列研究.
- 层次逻辑回归用于评估TC特定的手术神经外科手术率,调整患者因素.
- 根据手术干预倾向将TC分为四分之一;分析了与结果的关联.
主要成果:
- 观察到的显著差异:最高四分位数的TC对60%的合格患者进行了手术,而最低四分位数的TC为26%.
- 更高的外科手术TC倾向与降低住院患者死亡率 (aOR 0.7) 和增加有利出院率 (aOR 1.3) 相相关.
- 这些好处在异常瞳孔发现的患者中最为显著.
结论:
- 在创伤性SDH的外科治疗中存在相当大的中心间变异性.
- 创伤中心更倾向于进行外科手术,显示患者的生存率和功能结果有所改善.
- 制定基于共识的指导方针对于标准化护理和优化创伤性SDH的结果至关重要.
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