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Hematological factors predicting mortality in patients with traumatic epidural or subdural hematoma undergoing emergency surgical evacuation: A retrospective cohort study

 Na Young Kim  ;  Jaejoon Lim  ;  Seunghoon Lee  ;  Koeun Kim  ;  Jung Hwa Hong  ;  Duk-Hee Chun 
 MEDICINE, Vol.99(37) : e22074, 2020-09 
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Adult ; Aged ; Biomarkers / blood ; Craniotomy ; Creatinine / blood ; Emergency Service, Hospital ; Epinephrine / therapeutic use ; Female ; Glasgow Coma Scale ; Hematoma, Epidural, Cranial / blood* ; Hematoma, Epidural, Cranial / mortality ; Hematoma, Epidural, Cranial / surgery* ; Hematoma, Subdural, Intracranial / blood* ; Hematoma, Subdural, Intracranial / mortality ; Hematoma, Subdural, Intracranial / surgery* ; Humans ; Intraoperative Period ; Lymphocyte Count ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prognosis ; Retrospective Studies ; Vasoconstrictor Agents / therapeutic use
Hematological abnormalities at admission are common after traumatic brain injuries and are associated with poor outcomes. The objective of this study was to identify the predictive factors of mortality among patients who underwent emergency surgery for the evacuation of epidural hematoma (EDH) or subdural hematoma (SDH).This was a single-center retrospective cohort study of 200 patients who underwent emergency surgical evacuation of EDH or SDH between September 2010 and December 2018. Data on hematological parameters and clinical and intraoperative features were collected. The primary end-point was 1-year mortality after surgery. Univariate and multivariate analysis were performed, and the receiver operating characteristic (ROC) curves were assessed.Of the 200 patients included in this study, 102 (51%) patients died within 1 year of emergency surgery. Lymphocyte count at admission, creatinine levels, activated partial thromboplastin time (aPTT), age, intraoperative epinephrine use, and Glasgow Coma Scale (GCS) score were significantly associated with mortality in the multivariate analysis. The areas under the ROC curve for the GCS score, aPTT, and lymphocyte counts were 0.677 (95% confidence interval [CI] 0.602-0.753), 0.644 (95% CI 0.567-0.721), and 0.576 (95% CI 0.496-0.656), respectively.Patients with elevated lymphocyte counts on admission showed a higher rate of 1-year mortality following emergency craniectomy for EDH or SDH. In addition, prolonged aPTT and a lower GCS score were also related to poor survival.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
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