Abstract：
Patients with isolated traumatic subarachnoid hemorrhage (itSAH) are often transferred to a Level I or II trauma center for neurosurgical evaluation. Recent literature suggests that some patients, such as those with high Glasgow Coma Scale (GCS) scores, may be safely observed without neurosurgical consultation. The objective of this study was to investigate characteristics of patients with itSAH to determine the clinical utility of neurosurgical evaluation and repeat imaging.
A retrospective chart review of 350 patients aged ≥ 18 y with initial computed tomography head (CTH) showing itSAH and GCS scores of 13-15. Patient demographics, medical history, medications, length of stay, transfer status, injury type and severity, and CTH results were extracted for analysis. Bivariate analyses were conducted to determine whether any factors were associated with a worsening repeat CTH.
Most patients were female (57.4%) with blunt injuries (99.1%). The median age was 73 y. Neurosurgery was consulted for 342 (97.7%) patients, with one (0.3%) requiring intervention. Of 311 (88.9%) repeat imaging, 16 (5.1%) showed worsening. Factors with statistically significant associations with worsening CTH included injury severity; neurological deficit; lengths of stay; and a history of congestive heart failure, cirrhosis, or substance use disorder.
The findings suggest that patients with itSAH and high GCS scores may be able to be managed safely without neurosurgical oversight. The factors strongly associated with worsening CTH may be useful in identifying patients who need transfer for intensive care. Further research is needed to confirm these findings and develop appropriate management strategies for patients with itSAH.
A retrospective chart review of 350 patients aged ≥ 18 y with initial computed tomography head (CTH) showing itSAH and GCS scores of 13-15. Patient demographics, medical history, medications, length of stay, transfer status, injury type and severity, and CTH results were extracted for analysis. Bivariate analyses were conducted to determine whether any factors were associated with a worsening repeat CTH.
Most patients were female (57.4%) with blunt injuries (99.1%). The median age was 73 y. Neurosurgery was consulted for 342 (97.7%) patients, with one (0.3%) requiring intervention. Of 311 (88.9%) repeat imaging, 16 (5.1%) showed worsening. Factors with statistically significant associations with worsening CTH included injury severity; neurological deficit; lengths of stay; and a history of congestive heart failure, cirrhosis, or substance use disorder.
The findings suggest that patients with itSAH and high GCS scores may be able to be managed safely without neurosurgical oversight. The factors strongly associated with worsening CTH may be useful in identifying patients who need transfer for intensive care. Further research is needed to confirm these findings and develop appropriate management strategies for patients with itSAH.
摘要：
背景：患有孤立性外伤性蛛网膜下腔出血（itSAH）的患者通常被转移到I级或II级创伤中心进行神经外科评估。最近的文献表明，一些患者，例如格拉斯哥昏迷量表（GCS）得分高的人，无需神经外科咨询即可安全观察。这项研究的目的是研究其SAH患者的特征，以确定神经外科评估和重复成像的临床实用性。
方法：对350例年龄≥18岁的患者进行回顾性分析，初始计算机断层扫描头（CTH）显示其SAH和GCS评分为13-15。患者人口统计学，病史,药物,逗留时间,传输状态,损伤类型和严重程度，并提取CTH结果进行分析。进行双变量分析以确定是否有任何因素与重复CTH恶化相关。
结果：大多数患者为女性（57.4％），钝性损伤（99.1％）。中位年龄为73岁。对342例（97.7%）患者进行了神经外科咨询，其中一个（0.3％）需要干预。在311次(88.9%)重复成像中，16（5.1％）显示恶化。与CTH恶化有统计学意义的相关因素包括损伤严重程度、神经功能缺损、住院时间和充血性心力衰竭史。肝硬化,或物质使用障碍。
结论：研究结果表明，患有其SAH和高GCS评分的患者可能能够在没有神经外科监督的情况下得到安全管理。与CTH恶化密切相关的因素可能有助于识别需要转院进行重症监护的患者。需要进一步的研究来证实这些发现，并为其SAH患者制定适当的治疗策略。
方法：对350例年龄≥18岁的患者进行回顾性分析，初始计算机断层扫描头（CTH）显示其SAH和GCS评分为13-15。患者人口统计学，病史,药物,逗留时间,传输状态,损伤类型和严重程度，并提取CTH结果进行分析。进行双变量分析以确定是否有任何因素与重复CTH恶化相关。
结果：大多数患者为女性（57.4％），钝性损伤（99.1％）。中位年龄为73岁。对342例（97.7%）患者进行了神经外科咨询，其中一个（0.3％）需要干预。在311次(88.9%)重复成像中，16（5.1％）显示恶化。与CTH恶化有统计学意义的相关因素包括损伤严重程度、神经功能缺损、住院时间和充血性心力衰竭史。肝硬化,或物质使用障碍。
结论：研究结果表明，患有其SAH和高GCS评分的患者可能能够在没有神经外科监督的情况下得到安全管理。与CTH恶化密切相关的因素可能有助于识别需要转院进行重症监护的患者。需要进一步的研究来证实这些发现，并为其SAH患者制定适当的治疗策略。
