頭部外傷データバンクにおける急性期重症化症例の検討：プロジェクト2009と2015の比較検討

抄録

In some patients with severe head injury, a mild condition on arrival may be deteriorated in the acute phase, leading to a severe status. By analyzing Project 2015 (P2015) in the Japan Neurotrauma Data Bank (JNTDB), we investigated the course and characteristics of patients in whom the condition deteriorated in the acute phase. In this study, we report on the comparison with the previous Project 2009 (P2009).

The subjects were patients with GCS 9 or higher at the time of admission to hospital.

We compared the outcomes of patients with deterioration in the acute phase (deteriorated group) and those with early operation (operated group). The deteriorated group was 263 cases and the operated group was 107 cases. The favorable outcome was 50.2% in the deteriorated group and 70.1% in the operated group, and there was a significant difference between the two groups.

The mean time from the initial CT to the worst CT in minor cases of the deteriorated group was 6.1 hours for the favorable outcome group and 12.6 hours for the poor outcome group, with a significant difference between the two groups. In this study, the outcome of the minor cases in deteriorated group was worse than the result previous P2009. This result may be related to the extension in time from the initial CT to the worst CT.

We compared factors between the deteriorated group and the operated group. The significant difference between the two groups was the proportion of pedestrians in traffic accidents, Talk and Deteriorate (T&D), and CT findings with subarachnoid hemor­rhage. The factors that were significantly different in this study are the same as in the previous P2009 analysis. Therefore, it is considered to be an important factor as deteriorated factors.