頭部外傷データバンク登録症例におけるCT分類からの検討

抄録

The aim of this study was to investigate the diagnostic categories of types of intracranial abnormalities in patients with severe traumatic brain injury (TBI), and the influence of age and mechanism of injury on intracranial pathology. One thousand and two patients, aged 6 years or older, with severe TBI who registered to the Japan Neurotrauma Data Bank from 1998 to 2001 were target population for the data collection. Of these, the 115 patients with cardiopulmonary arrest on arrival and 81 patients with Glasgow Coma Scale score of 9 or more were excluded, leaving 799 patients in this study. Intracranial diagnosis was determined according to the Traumatic Coma Data Bank computerized tomography classification. Diagnosis of Diffuse Injury III, IV, evacuated subdural hematoma, or nonevacuated mass lesions was associated with unfavorable outcome. The proportion of Diffuse Injury was 52% in the patients under 40 years, while only 27% in those over 40 years of age. The proportion of evacuated subdural hematoma or nonevacuated mass lesions significantly increased with patient age. However, regardless of the intracranial diagnosis, older patients had poorer outcomes. Relatively high proportion of patients with Diffuse Injury was seen in traffic accidents. This can be explained, in part, by the greater proportion of young patients injured by traffic accidents. Different occurrence of intracranial lesion types according to age is likely caused by the disparity between the young and aged brain in the progression of secondary brain injury. Alteration in the pathophysiological response may contribute to more severe and irreversible brain damage in older patients, and associates with worse outcome.