Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
El-Shabrawi, J.
Risk Factors contributing to the Progression of Traumatic Brain Injury
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 56
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leitner Lukas
- Puchwein Paul
- Altmetrics:
- Abstract:
- Introduction: Traumatic brain injuries (TBI) are among one of the most common reasons for visits to the emergency department. The majority of patients with diagnosed TBI receive at least one cranial CT scan (CCT) and are hospitalized for observation. The ulterior motive of this strategy is to detect neurological deterioration, and initiate therapy if necessary. The aim of this thesis was to identify risk factors, which increased the likelihood of TBI progression. Material and Methods: We conducted a retrospective study, which comprised 2036 patients that were admitted to the Level I Trauma Center of the Department of Orthopaedics and Trauma at the Medical University of Graz from 2008-2018. Patients had to receive at least one CCT scan, and/ or be hospitalized to be included in this study. Following variables were assessed; age, sex, intake of antiplatelet/ anticoagulant therapy, concomitant diseases (coronary heart disease, kidney insufficiency, diabetes, atrial fibrillation, and previous ischemic strokes), alcohol abuse (acute and chronic), fracture of the neurocranium and intracranial hemorrhage in the course of TBI. Progression of TBI was defined as either intracranial hemorrhage on initial CCT scan, progression of hemorrhage on follow-up CCT scans, and/ or death 30 days after admission. Results: Out of 2036 patients, 1170 were male (57.4%) and 863 were female (42.4%). Mean age was 57.6 years (SD 22.6 years, min. 16.3 years, max. 103.7 years). 96.6% of patients (n=1968) received an initial CCT scan, and in 48.5% (n=988) radiologic follow-up was performed. Amongst all variables that were assessed following risk factors could be identified; concerning hemorrhage on initial CCT scans: age over 65 years (p<0.001), anticoagulant/ antiplatelet therapy (p<0.001), neurocranial fracture (p<0.001) alcohol abuse (p=0.002) and chronic kidney disease (p<0.001); concerning progression of hemorrhage on follow-up CCT scans: age over 65 years (p=0.025), neurocranial fracture (p<0.001); concerning 30-day mortality: age over 65 years (p<0.001), neurocranial fracture (p<0.001), antiplatelet/ anticoagulant therapy (p<0.001) and chronic kidney disease (p<0.001). Conclusion: TBI patients presenting to the ED with stated risk factors should be observed vigorously as progression of TBI is more likely than in other patients. Especially elderly patients seem to be at risk to develop TBI progression after trauma because they may obtain more than just one risk factor (e.g. age over 65 years, antiplatelet/ anticoagulant therapy, chronic kidney disease). Hence, attention should not only be stressed on close observation to prevent TBI progression, but also on prevention of trauma itself.