Abstract：
OBJECTIVE: To determine the incidence of vasospasm in traumatic brain injury patients with traumatic subarachnoid hemorrhage.
METHODS: IRB approval was obtained for this retrospective chart review. An institutional trauma database was queried for adult patients with traumatic brain injury (TBI) and traumatic subarachnoid hemorrhage (tSAH) seen on CT head obtained within 20 days. The presence of vasospasm on CTA was determined by radiology report. Association between categorical background characteristics and intracranial vasospasm was assessed by the chi-square test and association between a continuous variables and intracranial vasospasm was assessed by a paired t-test.
RESULTS: 1142 patients with traumatic SAH were identified from the trauma database. 792 patients were excluded: 142 for age <18, 632 did not have CT angiography, and 18 had non-traumatic SAH. 350 patients were analyzed, of which 28 (8 %) had vasospasm. Traumatic vasospasm was associated with higher-grade TBI based on Cochran-Armitage trend test (p < 0.05). Vasospasm patients had longer length of stay in the ICU (mean days 13.64 vs 7.24, P < 0.001), and had a higher incidence of death (39.29 % vs 20.81 %), although this did not reach statistical significance.
CONCLUSIONS: Intracranial vasospasm, specifically in patients with tSAH, is associated with more severe TBI and longer stays in the ICU. Our incidence is smaller compared to other studies likely due to the retrospective nature and the infrequency of obtaining CT angiography after initial presentation. Prospective studies are warranted as the incidence is significant and may represent a point of intervention for TBI.
METHODS: IRB approval was obtained for this retrospective chart review. An institutional trauma database was queried for adult patients with traumatic brain injury (TBI) and traumatic subarachnoid hemorrhage (tSAH) seen on CT head obtained within 20 days. The presence of vasospasm on CTA was determined by radiology report. Association between categorical background characteristics and intracranial vasospasm was assessed by the chi-square test and association between a continuous variables and intracranial vasospasm was assessed by a paired t-test.
RESULTS: 1142 patients with traumatic SAH were identified from the trauma database. 792 patients were excluded: 142 for age <18, 632 did not have CT angiography, and 18 had non-traumatic SAH. 350 patients were analyzed, of which 28 (8 %) had vasospasm. Traumatic vasospasm was associated with higher-grade TBI based on Cochran-Armitage trend test (p < 0.05). Vasospasm patients had longer length of stay in the ICU (mean days 13.64 vs 7.24, P < 0.001), and had a higher incidence of death (39.29 % vs 20.81 %), although this did not reach statistical significance.
CONCLUSIONS: Intracranial vasospasm, specifically in patients with tSAH, is associated with more severe TBI and longer stays in the ICU. Our incidence is smaller compared to other studies likely due to the retrospective nature and the infrequency of obtaining CT angiography after initial presentation. Prospective studies are warranted as the incidence is significant and may represent a point of intervention for TBI.
摘要：
目的：了解脑外伤合并外伤性蛛网膜下腔出血患者血管痉挛的发生率。
方法：此回顾性图表审查获得IRB批准。在机构创伤数据库中查询了20天内在CT头上看到的创伤性脑损伤（TBI）和创伤性蛛网膜下腔出血（tSAH）的成年患者。通过放射学报告确定CTA上是否存在血管痉挛。通过卡方检验评估分类背景特征与颅内血管痉挛之间的关联，并通过配对t检验评估连续变量与颅内血管痉挛之间的关联。
结果：从创伤数据库中确定了1142例创伤性SAH患者。792例患者被排除：142例年龄<18，632例没有CT血管造影，18人患有非创伤性SAH。350名患者进行了分析，其中28人（8%）有血管痉挛。根据Cochran-Armitage趋势检验，创伤性血管痉挛与高级别TBI相关（p<0.05）。血管痉挛患者在ICU的住院时间更长（平均13.64天vs7.24天，P<0.001），死亡率较高（39.29%vs20.81%），虽然没有达到统计学意义。
结论：颅内血管痉挛，特别是在tSAH患者中，与更严重的TBI和在ICU中停留更长的时间相关。与其他研究相比，我们的发病率较小，这可能是由于回顾性性质和初次就诊后获得CT血管造影的频率较低。前瞻性研究是有必要的，因为发病率很高，可能代表了TBI的干预点。
方法：此回顾性图表审查获得IRB批准。在机构创伤数据库中查询了20天内在CT头上看到的创伤性脑损伤（TBI）和创伤性蛛网膜下腔出血（tSAH）的成年患者。通过放射学报告确定CTA上是否存在血管痉挛。通过卡方检验评估分类背景特征与颅内血管痉挛之间的关联，并通过配对t检验评估连续变量与颅内血管痉挛之间的关联。
结果：从创伤数据库中确定了1142例创伤性SAH患者。792例患者被排除：142例年龄<18，632例没有CT血管造影，18人患有非创伤性SAH。350名患者进行了分析，其中28人（8%）有血管痉挛。根据Cochran-Armitage趋势检验，创伤性血管痉挛与高级别TBI相关（p<0.05）。血管痉挛患者在ICU的住院时间更长（平均13.64天vs7.24天，P<0.001），死亡率较高（39.29%vs20.81%），虽然没有达到统计学意义。
结论：颅内血管痉挛，特别是在tSAH患者中，与更严重的TBI和在ICU中停留更长的时间相关。与其他研究相比，我们的发病率较小，这可能是由于回顾性性质和初次就诊后获得CT血管造影的频率较低。前瞻性研究是有必要的，因为发病率很高，可能代表了TBI的干预点。
