Analysis Of Prognostic Factors Of Patients With Severe Traumatic Brain Injury Undergoing Decompressive Craniotomy

Objective: To study the prognostic risk factors of patients with severe traumatic brain injury undergoing decompressive craniotomy,analyze the predictive efficacy of risk factors on prognosis,and provide clinical early warning indicators and theoretical basis for the treatment and prognosis evaluation of decompressive craniotomy for severe traumatic brain injury.Methods: The clinical data of 204 patients with severe craniocerebral injury who underwent decompressive craniotomy in the department of neurosurgery and critical medicine of our hospital from January 2018 to December 2020 were collected retrospectively.Analyze the relation between age,GCS score,mydriasis,amount of intracranial hemorrhage,modified CT image score,time from injury to operation,multiple injuries,preoperative mean arterial pressure,postoperative intracranial pressure,hospital acquired pneumonia,hyperglycemia,hypernatremia,hypoproteinemia,surgical complications and the prognosis of patients.The risk factors that may affect the prognosis of patients with severe craniocerebral injury undergoing craniotomy were discussed through univariate analysis and multivariate logistic regression analysis.Drawn the receiver operating characteristic curve(ROC curve)affecting the prognostic risk factors of patients and analyze and calculate the area under the curve and the optimal threshold,so as to evaluate its efficacy in predicting the prognosis of patients.Results: Univariate analysis showed that age,GCS score,mydriasis,intracranial hematoma volume,modified CT image score,time from injury to operation,preoperative mean arterial pressure,postoperative intracranial pressure,hyperglycemia,hypernatremia,hospital acquired pneumonia,subdural effusion,postoperative rebleeding in the operation area or distant site,and traumatic hydrocephalus were correlated with the prognosis of patients,and the difference was statistically significant(p<0.05).Multivariate results showed that low GCS score,high modified CT image score,mydriasis,time from injury to operation(>6h),hyperglycemia,high postoperative intracranial pressure and traumatic hydrocephalus are the risk factors leading to poor prognosis(p <0.05).Meanwhile the ROC curve analysis showed that the GCS score has the best prediction efficiency[AUC:0.870,95% CI:(0.818-0.992)] and the highest accuracy,its optimal threshold,specificity,and sensitivity accuracy are 5.50,84.0%,84.6% and 75.2%.Mydriasis has the highest sensitivity(95.9%).And postoperative intracranial pressure has the highest specificity(87.7%),its threshold is 21.5mm Hg.Conclusion: The mortality and severe disability rate of patients which with severe traumatic brain injury after decompressive craniotomy are still high.There are many reasons affecting the prognosis of patients with severe traumatic brain injury after decompressive craniotomy.Low GCS score,high modified CT image score,mydriasis,time from injury to operation(>6h),hyperglycemia,high postoperative intracranial pressureand traumatic hydrocephalus are the risk factors leading to poor prognosis,which has good predictive efficiency.In clinical work,it is crucial to focus on the important risk factors related to poor prognosis and give timely intervention measures.