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Citation
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Parchani A, El-Menyar A, Al-Thani H, El-Faramawy A, Zarour A, Asim M, Latifi R. World Neurosurg. 2014; 82(5): e639-44. |
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Affiliation
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Department of Surgery, Trauma surgery Section, Hamad General Hospital, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar; Department of Surgery, Arizona University, Tucson, AZ, USA. |
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Abstract
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BACKGROUND: Traumatic brain injury (TBI) is a common cause of morbidity and mortality worldwide. It is difficult to estimate the real incidence of traumatic subarachnoid hemorrhage (TSAH). Despite the fact that TSAH following trauma is associated with poor prognoses, the impact of mechanism of injury and the pathophysiology remains unknown.. We hypothesized that outcome of TSAH caused by motor vehicle crash (MVC) or fall from height (FFH) varies based on the mechanism of injury.
METHODS: Data were collected retrospectively from a prospectively created database registry in the section of Trauma Surgery at Hamad General Hospital between January 2008 and July 2012. All patients presented with head trauma and TSAH were included. Patient data included age, gender, nationality, MOI, injury severity score (ISS), types of head injuries and associated injuries. Ventilator days, ICU length of stay, pneumonia and mortality were also studied.
RESULTS: A total of 1665 TBI patients were identified, of them 403 had TSAH with a mean age of 35±15 years. Of them 93% were males and 86% were expatriates. MVC (53%) and FFH (35%) were the major MOI. The overall mean ISS and head AIS were 19±10.6 and 3.4±0.96, respectively. Patients in MVC group sustained severe TSAH had significantly greater head AIS (3.5±0.9 vs. 3.2±0.9; p=0.009) and ISS (21.6±10.6 vs. 15.9±9.5; p=0.001) and lower scene GCS (10.8±4.8 vs. 13.2±3.4; p=0.001) compared to FFH group. Moreover, MVC group sustained more intraventricular hemorrhage (4.7 vs. 0.7; p=0.001) and diffuse axonal injury (4.2 vs. 2.9; p=0.001). In contrast, extradural hemorrhage (14.3% vs. 11.6%; p=0.008) was higher in FFH group. Lower extremities (14% vs. 4.3%; p=0.004) injury was mainly associated with MVC group. The overall mortality was 19 % among TSAH patients. The mortality rate was higher in MVC group when compared to FFH group (24% vs. 10%; p=0.001). In both groups, ISS and GCS at the scene were independent predictors of mortality.
CONCLUSION: Patients with TSAH have high mortality rate. In this group of population, MVCs are associated with a 3-fold increased risk of mortality. Therefore, prevention of MVC and fall can reduce the incidence and severity of TBI in Qatar.
Language: en |