Background: today we do not have many parameters in assessing the prognosis of patients operated on for acute post-traumatic subdural hematoma. Objective: identify prognostic factors significantly correlated with the prognosis of patients operated on for acute post-traumatic subdural hematoma, in order to make more accurate surgical indications Materials and Methods: the sample consists of 40 adult patients operated on for acute post-traumatic subdural hematoma in our AOU. Patients who did not have complete documentation were excluded from the study. the parameters examined are: age at the time of the trauma, sex, intake of anticoagulant / antiplatelet drugs, comorbidities (hypertension, diabetes mellitus, obesity, heart disease, coagulopathy, liver disease, chronic renal failure (CRF), chronic obstructive pulmonary disease (COPD) , coagulopathy), GCS upon admission to ED, presence of polytrauma, preoperative blood parameters (complete blood count, PT, PTT, INR, creatininemia, glycemia, neutrophil / lymphocyte ratio or NLR, platelet / lymphocyte ratio or PLR, platelet x neutrophils / lymphocytes or IBS, monocytes / lymphocytes ratio or MLR), operative timing, midline shift, flap thickness, flap thickness / midline shift (H / MS) ratio, associated lesions, mono or bilateral hematoma The outcome is was assessed using the Glasgow Outcome Scale (GOS). The correlation between parameters and outcome was by means of logistic regression (clinical-radiological parameters) and Mann-Whitney Test (preoperative haematochemical parameters). Results: Age ≤55 aa (p <0.0001 univariate, p = 0.0136 multivariate), GCS at access> 8 (p = 0.0007 univariate, p = 0) were significant in determining a better outcome , 0136 multivariate) H / MS> 1 (p = 0.0238 univariate, - multivariate), prolonged PTT (p = 0.0173) and high MLR (p = 0.0304) CI = 95%, significance p value <0.05. Conclusions: This study demonstrated the significance of age, GCS at access, MLR, PTT and H / MS. Limitations of the study: the smallness of the sample.
Background: ad oggi non disponiamo di molti parametri nel valutare la prognosi dei pazienti operati per ematoma subdurale acuto post-traumatico. Obiettivo: individuare fattori prognostici correlati in maniera significativa con la prognosi di pazienti operati per ematoma subdurale acuto post-traumatico, in modo da porre indicazioni chirurgiche più accurate Materiali e Metodi: il campione è costituito da 40 pazienti adulti operati per ematoma subdurale acuto post traumatico nella nostra AOU. i pazienti di cui non si disponeva di completa documentazione sono stati esclusi dallo studio. i parametri presi in esame sono:età al momento del trauma, sesso, assunzione di farmaci anticoagulanti/antiaggreganti, comorbidità (ipertensione, diabete mellito, obesità, cardiopatia, coagulopatia, epatopatia, insufficienza renale cronica (IRC), broncopneumopatia cronica ostruttiva (BPCO), coagulopatia), GCS all’ammissione in PS, presenza di politrauma, parametri ematochimici pre-operatori (emocromo completo, PT, PTT, INR, creatininemia, glicemia, rapporto neutrofili/linfociti o NLR, rapporto piastrine/linfociti o PLR, piastrine x neutrofili/linfociti o SII, rapporto monociti/linfociti o MLR), timing operatorio,midline shift, spessore di falda, rapporto spessore di falda/midline shift (H/MS), lesioni associate,mono o bilateralità dell’ematoma L'outcome è stato valutato tramite Glasgow Outcome Scale (GOS). La correlazione tra parametri e outcome è stata mediante regressione logistica (parametri clinico-radiologici) e Mann-Whitney Test (parametri ematochimici preoperatori). Risultati: sono risultati significativi nel determinare un miglior outcome l'età≤55 aa (p<0,0001 univariata, p=0,0136 multivariata), il GCS all'accesso > 8 (p=0,0007 univariata, p=0,0136 multivariata) H/MS>1 (p=0,0238 univariata, - multivariata), il PTT prolungato (p=0,0173) e l'MLR elevato (p=0,0304) IC=95%, significatività p value< 0,05. Conclusioni: questo studio ha dimostrato la significatività di età, GCS all'accesso, MLR, PTT e H/MS. Limiti dello studio: l'esiguità del campione.
Analisi dei fattori prognostici in pazienti operati per ematoma subdurale acuto post-traumatico
MIZIOLI, GIULIA
2020/2021
Abstract
Background: today we do not have many parameters in assessing the prognosis of patients operated on for acute post-traumatic subdural hematoma. Objective: identify prognostic factors significantly correlated with the prognosis of patients operated on for acute post-traumatic subdural hematoma, in order to make more accurate surgical indications Materials and Methods: the sample consists of 40 adult patients operated on for acute post-traumatic subdural hematoma in our AOU. Patients who did not have complete documentation were excluded from the study. the parameters examined are: age at the time of the trauma, sex, intake of anticoagulant / antiplatelet drugs, comorbidities (hypertension, diabetes mellitus, obesity, heart disease, coagulopathy, liver disease, chronic renal failure (CRF), chronic obstructive pulmonary disease (COPD) , coagulopathy), GCS upon admission to ED, presence of polytrauma, preoperative blood parameters (complete blood count, PT, PTT, INR, creatininemia, glycemia, neutrophil / lymphocyte ratio or NLR, platelet / lymphocyte ratio or PLR, platelet x neutrophils / lymphocytes or IBS, monocytes / lymphocytes ratio or MLR), operative timing, midline shift, flap thickness, flap thickness / midline shift (H / MS) ratio, associated lesions, mono or bilateral hematoma The outcome is was assessed using the Glasgow Outcome Scale (GOS). The correlation between parameters and outcome was by means of logistic regression (clinical-radiological parameters) and Mann-Whitney Test (preoperative haematochemical parameters). Results: Age ≤55 aa (p <0.0001 univariate, p = 0.0136 multivariate), GCS at access> 8 (p = 0.0007 univariate, p = 0) were significant in determining a better outcome , 0136 multivariate) H / MS> 1 (p = 0.0238 univariate, - multivariate), prolonged PTT (p = 0.0173) and high MLR (p = 0.0304) CI = 95%, significance p value <0.05. Conclusions: This study demonstrated the significance of age, GCS at access, MLR, PTT and H / MS. Limitations of the study: the smallness of the sample.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/1396