Clinical Evaluation And Risk Factors Of Progressive Hemorrhagic Injury After Acute Traumatic Brain Injury

Research Background:Traumatic brain injury is the common damage next only to the limbs injury,mostly due to traffic accidents,falling,violent trauma and so on.Although over years,the developments of brain injury first aid and treatment technology have made great progresses,the death and morbidity caused by head injury is still highest in the bodily damage.The main factors of the progressive injury after traumatic brain injury inlude bleeding,ischemia,cerebral edema,in which bleeding can cause significant deterioration of clinical symptoms.In clinical work we can often see some high GCS score patients after admission having progressive changes,which bring more difficulties to the initial assessment of the disease.Currently there are many studies on progressive hemorrhagic injury of traumatic brain damage,but we still find some shortcomings,such as 1)some factors are still controversial of not involved 2)there are still no quantitative predictive systems of progressive bleeding injury.So we hope to find the epidemiological factors of the progressive of craniocerebral trauma through retrospective analysis,And try to establish an evaluation system through which we can be easy to make a preliminary evaluation.Objective: To explore the risk factors of progressive hemorrhagic cerebral trauma and establish the grading system of brain trauma to test the effect on the progressive hemorrhagic injury.Methods: This study is divided into two parts.First,we collect 386 brain injury cases from January 2013 to June 2016,meetting the following criteria:1)patients with craniocerebral trauma 2)have at least one of the following imaging performance(1)skull fracture(2)brain contusion(3)brain hematoma(4)midline shift(5)brain swelling(6)point foci bleeding point(7)diffuse axonal injury(8)subarachnoid hemorrhage(9)skull base fracture(10)intracranial gas accumulation 3)imaging negative,but the coma,mental dysfunction,neurological dysfunction are difficult to use other system diseases to explain 4)The first head CT examination is completed when in the emergency or inpatient department 5)at least one head CT review,at the same time exclude1)Emergency surgical intervention at admission 2)history of anticoagulation therapy in the last 3 months 3)Less than 15 years old 4)admission of chronic obstructive pulmonary disease,liver disease,hemophilia,malignant tumors which may affect the coagulation system dysfunction 5)combined with serious other systems injuries.We divided the patients into two groups,PHI group and control group,which the definition of PHI is: new brain contusion,new intracranial hematoma Or the original brain contusion,intracranial hematoma volume increased more than 25% with comparison of the first CT image.series of clinical parameters were recorded including age,blood pressure,GCS score,coagulation fuction,hemostatic drugs,CT images,analyzing therisk factors by univariate and logistic statistical method.In the second part,we try to establish trauma grading system by CT imagings and risk factors.Total brain trauma patients from hospital were collected and divided into low-risk group,middle-risk group,high-risk group according to the grading system.The rate of progressive hemorrhagic injury,reduction of GCS after 24h(we took the preoperative GCS score as the final score if the patients needed emergency surgery within 24h)and the prognosis were separately analized.Results: in the first part: age,Initial CT scan time,multiple skull frature,hematoma size,shift size of midline,GCS core,and deline core after injury,Subarachnoid hemorrhage,D-dimer influence the development of progressive hemorrhagic injury.The gender,injury mechanism,admission blood pressure,blood sugar,coagulation function,hemostatic drug use have no significant statistical significance.Further multivariate logistics analysis found that age ≥65 years,D-dimer≥4mg/L,GCS decreased score(4-6h later)≥ 2 are independent risk factors.In the second part:Through our established grading system,there are 16 patients had progressive lesion in the low-risk group,18 PHI patients in moderate risk group,29 PHI patients in high risk group,There was a statistically significant difference between the groups;The score of GCS in the high risk group decreased 2.16±1.32,the moderate risk decreased 1.68±1.45 and the low risk decreased 1.31±1.06,which were statistically significant between the groups;GOS score was 2.09 ± 1.05 in the high risk group,3.55 ± 1.03 in the middle risk group and 4.07 ±2.02 in the low risk group,which were statistically significant.Conclusions: age ≥65 years,D-dimer≥4mg/L,,GCS decreased score(4-6h later)≥2 are independent risk factors of PHI;The progressive hemorrhage of brain trauma was evaluated effectively by Cerebral trauma grading system.