Talk & deteriorate症例の検討：自験例の報告と文献的考察

抄録

Introduction: We retrospectively analyzed surgically treated “talk and deteriorate (T&D)” patients at our institution to find an appropriate management of this potentially preventable poor outcome head injury.

Materials and Methods: From January 1996 to November 2014, a total of 468 patients with mild head injuries (GCS≧13) were admitted to our institution. Among these, 16 patients were identified as T&D. We defined T&D as a patient who utters comprehensible speech at some time after head injury and then deteriorates to a severe state (GCS score 8 or less) within 24 hours after injury. Clinical characteristics of these patients were analyzed.

Results: Of the 16 T&D patients, 10 were men, and 6 were women, aged 16–89 years (mean ± standard deviation (SD) = 65 ± 19). Thirteen patients were injured in non high energy trauma. All deterioration was due to intra-cranial hematomas, mostly acute subdural hematoma. Time interval from accident to deterioration was 1–15 hours (mean ± SD ＝ 4.4 ± 4.0). All patients underwent craniotomy, two of these craniectoy and 5 indwelled intracranial pressure monitoring. Two died and 6 were left in moderate disability or severe disability status. The remaining 8 patients had good outcome.

Conclusion: The most important factors in saving these patients are rapid diagnosis and immediate surgical decompression before irreversible brain damage sets in.