Predictive Value Of A New Type Of Frontal Brain Contusion Score For The Clinical Deterioration Of Patients In Traumatic Brain Injury

Objective: Based on the shape of the contusion in brain CT scan,a new frontal contusion score(FCS)was proposed and the predictive value of the traumatic brain injury was evaluated.Methods: This study retrospectively analyzed data from 206 consecutive patients with isolated frontal contusion who visited the Huashan hospital neurosurgery neurotrauma center at Fudan university,China between December 2007 and June 2016.First,based on the CT results,we define FCS and FCS scores were scored on 206 patients.Second,206 patients were divided into groups with acute neurological deterioration,and their clinical characteristics(including FCS score)were counted.128 patients with intracranial pressure(ICP)were divided into two groups according to whether or not refractory intracranial hypertension was included and the clinical characteristics(including FCS score).Finally,the independent risk factors of acute neurological deterioration and refractory intracranial hypertension were screened by logistic multivariate progressive method,and the ROC curve was drawn based on FCS score.After adjusting the variables,the correlation between FCS and acute neurological deterioration and refractory intracranial hypertension was analyzed by binomial distribution.The follow-up of glasgow outcome scale(GOS)was used to predict the 6-month mortality and adverse prognostic risk factors.Results:(1)In this study,206 patients with frontal lobe contusion were treated,including 72 patients(34.9%)with acute neurological deterioration and 134(65.1%)without acute neurological deterioration.Multivariate analysis indicated FCS,obliteration of the basal cistern,and a serum sodium decrease of more than 10 mmol/L within 24 hours were independent predictors of acute neurological deterioration.Of the 128 patients(62.1%)who underwent ICP monitoring,92(71.9%)underwent ICP monitoring immediately after arriving at the hospital.Multivariate analysis indicated FCS and obliteration of the basal cistern suggested predictive of refractory intracranial hypertension.(2)After adjusting for other factors,the FCS was divided dichotomously,we found that the risk of developing refractory intracranial hypertension was 2.7 times higher for patients with a FCS 5-8 than for those with a FCS 1-4;the risk of developing acute neurological deterioration for patients with FCS 5-8 was nearly 3 times higher than that for those with FCS 1-4.(3)Only glasgow coma scale(GCS)at admission,age,and acute neurological deterioration were independent predictors of the 6-month mortality and 6-month unfavorable outcome.Conclusion:(1)Based on the results of CT,the FCS score can be used to describe the frontal lobe contusion patients conveniently and accurately in order to guide the clinical treatment;(2)FCS score can be used to predict the severity of frontal lobe contusion and laceration of the brain,FCS is positively correlated with neurological deterioration and intracranial hypertension,that is,the higher the FCS,the corresponding increase in incidence.(3)Follow-up GOS,regression analysis showed that only age,admission GCS score,acute neurological deterioration is an independent risk factor for 6-month mortality and 6-month adverse prognosis.