Hematoma Density and Glasgow Coma Scale are Independent Predictors to Outcomes in Unilateral Chronic Subdural Hematoma

前言：使用昏迷指數(Glasgow Coma Scale)，預後指數(Glasgow Out-come Scale)，及電腦斷層(CT)的變項，來評估慢性硬腦膜下出血(CSDH)預後，文獻上並無一致性結論。方法：從94年10月至98年3月，共收集了93例單一側CSDH的病人（年齡71±11歲）。每位病患皆於急診接受電腦斷層檢查並手術。排除了雙側硬腦膜下出血（由兩位放射專家確任），我們使用多個變項，如年齡、性別、昏迷指數、到院時間、出血位置、大小、厚度、密度(density)、腦移位情形、腦室大小(Evan's index)、第3腦室最大寬度(3Vmax. D)、皮質委縮等，來評估上述何者為最佳之預測因子。結果：使用單變項及多變項分析，昏迷指數＜15預測不良預後爲一般的11倍之多(OR=11.2, CI=1.3-96.9, p=0.028)，出血密度高達7倍(OR=7.4, CI=1.8-31.7, p=0.007)，兩者皆呈統計性意義。利用Receiver-Operating Characteristic来測量兩者的顯著情形，敏感度高達73%，專一度爲85%。結論：在本前驅性觀察研究發現，單一側硬腦膜下出血對於預後不良的最佳預測因子，爲出血密度及昏迷指數，預測敏感度高於7成。不同於以往文獻多為合併單、雙側病兆、或顱內出血討論，本文病患雖然不多，但仍具參考價值及意義。對於區域或社區型醫院之轉診，提供病患較準確評估及說明。

關鍵字

單側硬腦膜下出血；昏迷指數；預後指數；預測因子

並列摘要

Introduction: The relationships between Glasgow Outcome Scale (GOS), Glasgow Coma Scale (GCS) and brain computerized tomography (CT) with unilateral chronic subdural hematoma (CSDH) are not consistent in studies. Methods: Between Oct 2005 to March 2009, 93 unilateral CSDH patients (mean age 71±11 years) were enrolled for analysis. The associations between GOS at discharge and the following variables on admission including sex, age, GCS, time interval from injury to emergency room, hematoma site, hematoma thickness, hematoma density, midline shift, ventricular sizes (Evan's index and maximum diameter of third ventricle-3Vmax. D), and cortical atrophy on brain CT were evaluated. Results: By multiple logistic regression statistics, the adjusted odds ratio (OR) in predicting the poor outcome was significant with GCS ＜15 [OR=11.2, CI=1.3-96.9, p=0.028] and mixed density hematoma on brain CT [OR=7.4, CI=1.8-31.7, p=0.007]. Using Receiver-Operating Characteristic (ROC) curve, the sensitivity was 73% and the specificity was 85%. Conclusions: In our preliminary study that mixed hematoma density and lower GCS were associated with poor prognosis in unilateral CSDH with sensitive prediction.

並列關鍵字

Unilateral chronic subdural hematoma ； Glasgow Coma Scale ； Glasgow Outcome Scale ； Prognostic factors

國際替代計量

Hematoma Density and Glasgow Coma Scale are Independent Predictors to Outcomes in Unilateral Chronic Subdural Hematoma

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