İzole İntrakraniyal Epidural Hematomda Cerrahi Müdahaleye Karar Vermede ve Hastanın Prognozunda Prediktif Parametreler

Abstract

Amaç: Bu çalışma, izole intrakraniyal epidural hematom (EDH) tanısı alan hastaların hastaneye kabulünden elde edilen klinik, laboratuvar ve radyolojik parametreleri kullanarak cerrahi müdahale kararı verme ve prognozunu öngörmeyi amaçladı. Gereç ve Yöntem: "Yüksekten düşme" veya "trafik kazası" nedeniyle EDH gelişen 83 hastanın verileri incelendi. Her hastanın yaşı, cinsiyeti, hastaneye başvuru anındaki Glasgow Koma Skalası (GCS) skorları, anizokori, yoğun bakım ve hastanede kalış süreleri ve Glasgow Sonuç Skalası skorları kaydedildi. Hastaneye başvuruda elde edilen beyin BT görüntüleri incelenerek hematom kalınlığı ve orta hat kayması değerleri ölçüldü. Ayrıca hastaların hastaneye başvuru anından itibaren elde edilen kan biyokimyası sonuçları da kaydedildi. Bulgular: ROC eğrisi analizi, preoperatif hematom kalınlığı ve orta hat kayması değerleri, bazofil sayısı ve serum potasyum düzeyi değerlerinin pediatrik hastalarda cerrahi müdahale kararının verilmesinde belirleyici parametreler olabileceğini ortaya koydu. Ayrıca ameliyat öncesi hematom kalınlığı ve orta hat kayması değerleri, serum sodyum, potasyum, ALT ve CRP değerleri erişkin hastalarda cerrahi müdahale kararını öngörebilecek parametreler olabileceği saptandı. Son olarak, regresyon analizi GCS skorlarının ve serum sodyum değerlerinin hastaların erken prognozunu öngörebileceğini ortaya koydu. Sonuç: Çalışma sonuçları, izole EDH'li hastalarda cerrahi müdahaleye karar vermede hematom kalınlığı, orta hat kayması değerleri ve bazı kan biyokimyası parametrelerinin öngörücü belirteçler olarak kullanılabileceğini düşündürdü. Ayrıca hastaneye başvuru sırasında belirlenen GCS skorunun hastaların erken dönem prognozunu öngörmede bir belirteç olarak kullanılabileceği savunuldu.

Keywords

• Epidural hematom
• cerrahi
• prognoz.

PREDICTIVE PARAMETERS IN DECISION-MAKING FOR SURGICAL INTERVENTION AND PATIENTS' PROGNOSIS IN ISOLATED INTRACRANIAL EPIDURAL HEMATOMA

Abstract

Objective: This study aimed to predict surgical intervention decision and early prognosis in patients with isolated intracranial epidural hematoma (EDH) using clinical, laboratory, and radiological parameters obtained at admission to the hospital. Materials and Methods: Eighty-three patients with EDH due to "fall from a height" or "traffic accident" were examined. For each patient, age, gender, Glasgow Coma Scale (GCS) scores on admission to the hospital, anisocoria, duration of stay in the intensive care unit and the hospital, and Glasgow Outcome Scale scores were recorded. Brain CT images obtained on admission to the hospital were examined, and the hematoma thickness and midline shift values were measured. Additionally, patients' blood biochemistry results were recorded. Results: ROC curve analysis revealed that hematoma thickness, midline shift, basophil count, and serum potassium level were predictive parameters for surgical intervention in pediatric patients. In addition, preoperative hematoma thickness and midline shift, serum sodium, potassium, ALT, and CRP values could predict the decision to perform surgical intervention in adult patients. Finally, GCS scores and serum sodium values could predict patients' early outcomes. Conclusion: The study results suggested that hematoma thickness, midline shift values, and some blood biochemistry parameters could be used as predictive markers in the decision-making for surgical intervention in patients with isolated EDH. Additionally, the GCS score determined at admission to the hospital could be used as a predictive marker of patients’ early prognosis.

Keywords

• Epidural hematoma
• surgery
• prognosis.

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