CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e108-e136
DOI: 10.1055/s-0042-1742299
Original Article

Prognosis in Traumatic Brain Injury

Indicadores prognósticos no trauma cranioencefálico
1   Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
,
2   Department of Neurosurgery, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
3   Department of Neurosurgery, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil
,
3   Department of Neurosurgery, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil
,
4   Department of Neurosurgery, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
,
4   Department of Neurosurgery, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
5   Department of Neurosurgery, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brazil
› Author Affiliations

Abstract

Objective To characterize the profile of TBI victims who required neurosurgical approach in two reference hospitals in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil, and to identify the prognostic increase in the Pupil Reactivity Score when subtracted from the Glasgow Coma Score, found in the Glasgow-P. Additionally, to present demographic, etiological, clinical, and tomographic data, and associate them with the outcome of death.

Methods Medical record data and computed tomography (CT) scans of patients with TBI undergoing neurosurgical procedures from January 2014 to April 2019, at 2 reference hospitals in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil – Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ-HMG, in the Portuguese acronym) and Hospital Governador Celso Ramos (HGCR, in the Portuguese acronym).

Results The results of the 318 cases studied indicated that the male gender predominated (87.7%). The most affected age group was between 35 and 65 years old (47.5%). The main cause was motorcycle accidents (26.1%), followed by a fall from a height (16.4%). Most patients required admission to the intensive care unit (ICU) (85.8%), with an average duration of 13 days. The average total hospital stay was 28 days. Most cases needed external ventricular drain (EVD) (64.8%). The predominant tomographic classification was Marshall II (43.4%), followed by Marshall IV (26.1%). Most patients presented with extra-axial hematoma (64.2%), with subdural hematoma (SDH) being the most frequent (45%). Most patients presented with sequelae at hospital discharge (43.4%).

Conclusion There was no clinically relevant increase between the Glasgow and Glasgow-P scores for the tested outcomes (need for decompressive craniectomy, midline shift, presence of basal cisterns obliteration, need for ICU admission, and death).

Resumo

Objetivos Caracterizar o perfil das vítimas de trauma cranioencefálico (TCE) que necessitaram de abordagem neurocirúrgica em dois hospitais de referência na Grande Florianópolis, SC, Brasil, e identificar o incremento prognóstico do Escore de Reatividade Pupilar quando subtraído do Escore de Coma de Glasgow, resultando no Glasgow-P. Ademais, apresentar dados demográficos, etiológicos, clínicos e tomográficos, e associá-los ao desfecho óbito.

Métodos Foram analisados dados de prontuários e exames tomográficos de pacientes com TCE submetidos a procedimentos neurocirúrgicos no período de janeiro de 2014 a abril de 2019, em 2 hospitais de referência na Grande Florianópolis – Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ-HMG) e Hospital Governador Celso Ramos (HGCR).

Resultados Para os 318 casos analisados, os resultados mostraram que o sexo masculino predominou (87,7%). A faixa etária mais acometida foi de 35 a 65 anos (47,5%). A principal causa foi acidente motociclístico (26,1%), seguido por queda de nível (16,4%). A maioria dos pacientes necessitou de internação na unidade de tratamento intensive (UTI) (85,8%), com duração média de 13 dias. O tempo médio total de internação hospitalar foi de 28 dias. Houve necessidade de derivação ventricular externa (DVE) na maior parte dos casos (64,8%). A classificação tomográfica predominante foi Marshall II (43,4%), seguida pelo Marshall IV (26,1%). A maioria dos pacientes apresentou hematoma extra-axial (64,2%), sendo o hematoma subdural (HSD) o mais frequente (45%). A maoria dos pacientes apresentou sequelas na alta hospitalar (43,4%).

Conclusão Não houve um incremento clinicamente relevante entre os escores Glasgow e Glasgow-P para os desfechos testados (necessidade craniectomia descompressiva, desvio da linha média (DLM), presença de obliteração de cisternas basais, necessidade de internação em UTI e óbito).

Institutions in Which the Present Work was Performed

Hospital Regional de São José Doutor Homero de Miranda Gomes (HRSJ-HMG).


Hospital Governador Celso Ramos (HGCR).




Publication History

Received: 19 August 2021

Accepted: 13 October 2021

Article published online:
09 February 2022

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