외상성 급성 뇌경막하출혈에서 수술시기의 적정성 (Operative Timing in Patients with Traumatic Acute Subdural Hematomas)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 19권 / 6호 / 678 ~ 685페이지
· 저자명 : 박귀웅, 김익범, 고혁상, 오용해, 최덕수, 박희정, 최일국, 오성범

초록

Purpose: Acute traumatic subdural hematoma (SDH)
increases after severe traumatic brain injury (TBI) and leads
to high mortality. The time to operation is a correctable
prognostic factor in TBI, but the timing of hematoma evacuation
still remains controversial. We assessed the correlation
between operative timing and mortality in traumatic
acute SDH.
Methods: We conducted a retrospective study over an 8-
year period in 163 surgical patients with acute traumatic
SDH. Information was obtained about demographic, clinical,
and radiological findings, surgical management, and
mortality at discharge.
Results: Overall, 85 patients (52.1%) died, and 47 patients
(28.8%) showed good recovery. The patients who underwent
earlier surgery were more likely to have severe head
injury. The time to operation in patients that died was shorter
than patients with good recovery. The mean time for evacuation
[Ed-Is this the same as time to surgery, or is this specifically
when the hematoma was removed? Please clarify.]
was 351.7±220.5 minutes in patients who died and 395.5±
363.3 minutes in patients with good recovery. Patients
undergoing surgery within 4 hours of injury had a mortality
rate of 54.4% versus 50.9% receiving surgery after 4 hours.
But the risk ratio for time spent to surgery increased until 240
minutes and then decreased. Logistic regression on patients
with 240 minutes until surgery showed that the probability of
death increased with time to surgery.
Conclusion: Patients who undergo surgery within 180 minutes
after injury have a lower probability of death than those
with delayed surgery.

영어초록

Purpose: Acute traumatic subdural hematoma (SDH)
increases after severe traumatic brain injury (TBI) and leads
to high mortality. The time to operation is a correctable
prognostic factor in TBI, but the timing of hematoma evacuation
still remains controversial. We assessed the correlation
between operative timing and mortality in traumatic
acute SDH.
Methods: We conducted a retrospective study over an 8-
year period in 163 surgical patients with acute traumatic
SDH. Information was obtained about demographic, clinical,
and radiological findings, surgical management, and
mortality at discharge.
Results: Overall, 85 patients (52.1%) died, and 47 patients
(28.8%) showed good recovery. The patients who underwent
earlier surgery were more likely to have severe head
injury. The time to operation in patients that died was shorter
than patients with good recovery. The mean time for evacuation
[Ed-Is this the same as time to surgery, or is this specifically
when the hematoma was removed? Please clarify.]
was 351.7±220.5 minutes in patients who died and 395.5±
363.3 minutes in patients with good recovery. Patients
undergoing surgery within 4 hours of injury had a mortality
rate of 54.4% versus 50.9% receiving surgery after 4 hours.
But the risk ratio for time spent to surgery increased until 240
minutes and then decreased. Logistic regression on patients
with 240 minutes until surgery showed that the probability of
death increased with time to surgery.
Conclusion: Patients who undergo surgery within 180 minutes
after injury have a lower probability of death than those
with delayed surgery.

참고자료

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