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Abstract：
The primary aim was to determine the association of intracranial hemorrhage lesion type, size, mass effect, and evolution with the clinical course during neurointensive care and long-term outcome after traumatic brain injury (TBI).
In this observational, retrospective study, 385 TBI patients treated at the neurointensive care unit at Uppsala University Hospital, Sweden, were included. The lesion type, size, mass effect, and evolution (progression on the follow-up CT) were assessed and analyzed in relation to the percentage of secondary insults with intracranial pressure > 20 mmHg, cerebral perfusion pressure < 60 mmHg, and cerebral pressure autoregulatory status (PRx) and in relation to Glasgow Outcome Scale-Extended.
A larger epidural hematoma (p < 0.05) and acute subdural hematoma (p < 0.001) volume, greater midline shift (p < 0.001), and compressed basal cisterns (p < 0.001) correlated with craniotomy surgery. In multiple regressions, presence of traumatic subarachnoid hemorrhage (p < 0.001) and intracranial hemorrhage progression on the follow-up CT (p < 0.01) were associated with more intracranial pressure-insults above 20 mmHg. In similar regressions, obliterated basal cisterns (p < 0.001) were independently associated with higher PRx. In a multiple regression, greater acute subdural hematoma (p < 0.05) and contusion (p < 0.05) volume, presence of traumatic subarachnoid hemorrhage (p < 0.01), and obliterated basal cisterns (p < 0.01) were independently associated with a lower rate of favorable outcome.
The intracranial lesion type, size, mass effect, and evolution were associated with the clinical course, cerebral pathophysiology, and outcome following TBI. Future efforts should integrate such granular data into more sophisticated machine learning models to aid the clinician to better anticipate emerging secondary insults and to predict clinical outcome.
In this observational, retrospective study, 385 TBI patients treated at the neurointensive care unit at Uppsala University Hospital, Sweden, were included. The lesion type, size, mass effect, and evolution (progression on the follow-up CT) were assessed and analyzed in relation to the percentage of secondary insults with intracranial pressure > 20 mmHg, cerebral perfusion pressure < 60 mmHg, and cerebral pressure autoregulatory status (PRx) and in relation to Glasgow Outcome Scale-Extended.
A larger epidural hematoma (p < 0.05) and acute subdural hematoma (p < 0.001) volume, greater midline shift (p < 0.001), and compressed basal cisterns (p < 0.001) correlated with craniotomy surgery. In multiple regressions, presence of traumatic subarachnoid hemorrhage (p < 0.001) and intracranial hemorrhage progression on the follow-up CT (p < 0.01) were associated with more intracranial pressure-insults above 20 mmHg. In similar regressions, obliterated basal cisterns (p < 0.001) were independently associated with higher PRx. In a multiple regression, greater acute subdural hematoma (p < 0.05) and contusion (p < 0.05) volume, presence of traumatic subarachnoid hemorrhage (p < 0.01), and obliterated basal cisterns (p < 0.01) were independently associated with a lower rate of favorable outcome.
The intracranial lesion type, size, mass effect, and evolution were associated with the clinical course, cerebral pathophysiology, and outcome following TBI. Future efforts should integrate such granular data into more sophisticated machine learning models to aid the clinician to better anticipate emerging secondary insults and to predict clinical outcome.
摘要：
背景：主要目的是确定颅内出血病变类型，尺寸,质量效应,以及神经重症监护期间的临床过程和创伤性脑损伤（TBI）后的长期结果的演变。
方法：在这个观察中，回顾性研究,385名TBI患者在乌普萨拉大学医院的神经重症监护病房接受治疗，瑞典,包括在内。病变类型,尺寸,质量效应,和演变（随访CT的进展）评估并分析了颅内压>20mmHg的继发性损伤的百分比，脑灌注压<60mmHg，和脑压自动调节状态（PRx）以及与格拉斯哥结局量表扩展的关系。
结果：较大的硬膜外血肿（p<0.05）和急性硬膜下血肿（p<0.001）的体积，中线偏移更大(p<0.001)，和压缩的基底池（p<0.001）与开颅手术相关。在多元回归中，外伤性蛛网膜下腔出血的存在(p<0.001)和随访CT上颅内出血进展(p<0.01)与高于20mmHg的更多颅内压损伤相关.在类似的回归中，闭塞的基底池(p<0.001)与较高的PRx独立相关。在多元回归中，急性硬膜下血肿（P<0.05）和挫伤（P<0.05）体积，外伤性蛛网膜下腔出血的存在（P<0.01），和闭塞的基底池（p<0.01）与较低的有利结局率独立相关。
结论：颅内病变类型，尺寸,质量效应,和进化与临床过程有关，脑病理生理学，以及TBI后的结果。未来的努力应该将这样的粒度数据集成到更复杂的机器学习模型中，以帮助临床医生更好地预测新出现的继发性损伤并预测临床结果。
方法：在这个观察中，回顾性研究,385名TBI患者在乌普萨拉大学医院的神经重症监护病房接受治疗，瑞典,包括在内。病变类型,尺寸,质量效应,和演变（随访CT的进展）评估并分析了颅内压>20mmHg的继发性损伤的百分比，脑灌注压<60mmHg，和脑压自动调节状态（PRx）以及与格拉斯哥结局量表扩展的关系。
结果：较大的硬膜外血肿（p<0.05）和急性硬膜下血肿（p<0.001）的体积，中线偏移更大(p<0.001)，和压缩的基底池（p<0.001）与开颅手术相关。在多元回归中，外伤性蛛网膜下腔出血的存在(p<0.001)和随访CT上颅内出血进展(p<0.01)与高于20mmHg的更多颅内压损伤相关.在类似的回归中，闭塞的基底池(p<0.001)与较高的PRx独立相关。在多元回归中，急性硬膜下血肿（P<0.05）和挫伤（P<0.05）体积，外伤性蛛网膜下腔出血的存在（P<0.01），和闭塞的基底池（p<0.01）与较低的有利结局率独立相关。
结论：颅内病变类型，尺寸,质量效应,和进化与临床过程有关，脑病理生理学，以及TBI后的结果。未来的努力应该将这样的粒度数据集成到更复杂的机器学习模型中，以帮助临床医生更好地预测新出现的继发性损伤并预测临床结果。
