原著
院内発症の急性硬膜下血腫の検討
2019 年 42 巻 1 号 p. 39-44
詳細
2019 年 42 巻 1 号 p. 39-44
Background: Although various precautions against fall accidents during hospitalization are taken in every medical facility, some accidents are fatal to the patients.
Methods: We retrospectively analyzed 11 patients with acute subdural hematoma caused by fall accidents during hospitalization who were treated at National Hospital Organization Tokyo Medical Center from April 2014 to December 2018. They were divided into two groups: the poor prognosis group comprised six patients with GOS (Glasgow Outcome Scale) score 1 or 2 (dead or vegetative state, respectively); and the good prognosis group included five patients otherwise. Between these groups we compared age, Glasgow Coma Scale (GCS), computed tomography (CT) findings, primary disease and its treatment, antiplatelet agents or anticoagulants, systolic blood pressure at admission, medical history of diabetes mellitus, hemoglobin count, platelet count, prothrombin time–international normalized ratio (PT–INR), and hypnotics before sleep.
Results: All patients were over 65 years old. In the poor prognosis group, platelet count was significantly lower than that in the good prognosis group (p=0.02), and every patient had been taking antiplatelet agents or had platelet count lower than 50,000/µl. Also, both the maximum width of subdural hematoma and distance of midline shift measured on CT scans significantly exceeded those in the mild cases group (p=0.01, 0.03, respectively). Importantly, of the six patients in the poor prognosis group, four had malignant neoplasm and three had been undergoing chemotherapy, whereas only one patient had cancer and no patient was under anticancer drugs in the good prognosis group.
Conclusions: In general, acute subdural hematoma is frequently caused by accidents such as traffic accidents or fall after consuming alcohol. However, the current study may suggest that in hospital we should be careful of elderly patients falling whose primary hemostatic mechanism might be impaired by tumor–bearing, chemotherapy, and antiplatelet agents or anticoagulants.
