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Größenprogrediente intrakranielle Blutungen nach Schädel-Hirn-Trauma

Wann ist eine Kontroll-CCT erforderlich?

Progredient intracranial bleeding after traumatic brain injury

When is a control CCT necessary?

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Zusammenfassung

Hintergrund

Ziel der Untersuchung war die Erfassung der Häufigkeit größenprogredienter intrakranieller Blutungen (PIB) bei SHT-Patienten und die Identifikation möglicher Begleitparameter.

Material und Methoden

Eingeschlossen wurden SHT-Patienten, die einer initialen CCT sowie einer Kontroll-CCT innerhalb der ersten 24 h nach Trauma unterzogen wurden. Als Blutungsprogression wurde eine Befundprogredienz über 25% gewertet.

Ergebnisse

98 SHT-Patienten mit intrakranieller Blutung konnten retrospektiv ausgewertet werden. Dabei zeigten 45 PIB-Patienten signifikant häufiger intrazerebrale Kontusionsblutungen und Frakturen der Schädelkalotte (p<0,05) als Patienten mit konstantem Befund. Keine signifikanten Gruppenunterschiede fanden sich hinsichtlich demografischer und klinischer Parameter, Zeitintervall vom Trauma zum 1. CCT sowie des Gerinnungsstatus.

Schlussfolgerung

Eine frühe Größenprogredienz tritt bei etwa der Hälfte der SHT-Patienten mit initial diagnostizierter intrakranieller Blutung auf und wird häufiger bei Kontusionsblutung oder kombinierter Kalottenfraktur beobachtet. Eine frühzeitige CCT-Kontrolle ist bei SHT-Patienten mit intrakranieller Blutung indiziert.

Abstract

Background

The aim of the study was to quantify the occurrence of progressive intracranial bleeding (PIB) and to identify concomitant parameters in patients suffering from traumatic brain injury (TBI).

Methods

TBI patients were included if initial and serial cranial computed tomography (CCT) scans were conducted within 24 h after trauma. A progression of ≥25% was considered as PIB. Patients with progression were compared to those with constant bleeding regarding clinical parameters, time lapse and coagulation status.

Results

A total of 98 patients with TBI and intracranial hemorrhaging were analyzed. PIB was detected in 45 patients showing significantly more intracerebral bleeding as well as fractures to the skull (p<0.05), compared to patients with constant bleeding. No significant differences between the groups regarding demographic and clinical parameters, time interval between trauma and initial CCT, and coagulation status were found.

Conclusions

Early progression of intracranial hemorrhaging occurs in nearly every second TBI patient and is recognized frequently in cerebral contusions and after fractures to the skull. Hence, early repeated CT scanning is indicated in all TBI patients suffering from intracranial bleeding.

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Literatur

  1. Borczuk P (1995) Predictors of intracranial injury in patients with mild head trauma. Ann Emerg Med 25: 731–736

    Article  PubMed  CAS  Google Scholar 

  2. Brown CV, Weng J, Oh D et al. (2004) Does routine serial computed tomography of the head influence management of traumatic brain injury? A prospective evaluation. J Trauma 57: 939–943

    PubMed  Google Scholar 

  3. Brown CV, Zada G, Salim A et al. (2007) Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. J Trauma 62: 1339–1345

    PubMed  Google Scholar 

  4. Chao A, Pearl J, Perdue P et al. (2001) Utility of routine serial computed tomography for blunt intracranial injury. J Trauma 51: 870–875; discussion 875–876

    PubMed  CAS  Google Scholar 

  5. Chieregato A, Fainardi E, Morselli-Labate AM et al. (2005) Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery 56: 671–680; discussion 671–680

    Article  PubMed  Google Scholar 

  6. DGU APd (2002) Jahresbericht 2002 des Traumaregisters

  7. Dharap SB, Khandkar AA, Pandey A, Sharma AK (2005) Repeat CT scan in closed head injury. Injury 36: 412–416

    Article  PubMed  CAS  Google Scholar 

  8. Engstrom M, Romner B, Schalen W, Reinstrup P (2005) Thrombocytopenia predicts progressive hemorrhage after head trauma. J Neurotrauma 22: 291–296

    Article  PubMed  Google Scholar 

  9. Falimirski ME, Gonzalez R, Rodriguez A, Wilberger J (2003) The need for head computed tomography in patients sustaining loss of consciousness after mild head injury. J Trauma 55: 1–6

    PubMed  Google Scholar 

  10. Harad FT, Kerstein MD (1992) Inadequacy of bedside clinical indicators in identifying significant intracranial injury in trauma patients. J Trauma 32: 359–361; discussion 361–353

    PubMed  CAS  Google Scholar 

  11. Haydel MJ, Preston CA, Mills TJ et al. (2000) Indications for computed tomography in patients with minor head injury. N Engl J Med 343: 100–105

    Article  PubMed  CAS  Google Scholar 

  12. Kaups KL, Davis JW, Parks SN (2004) Routinely repeated computed tomography after blunt head trauma: does it benefit patients? J Trauma 56: 475–480; discussion 480–471

    PubMed  Google Scholar 

  13. Kuhne CA, Homann M, Ose C et al. (2003) Der Schockraumpatient. Einschatzung ernster Schadelverletzungen anhand der GCS bei vermeintlich leichtem und mittelschwerem Schädel-Hirn-Trauma. Unfallchirurg 106: 380–386

    Article  PubMed  CAS  Google Scholar 

  14. Lehmann U, Regel G, Ellendorf B et al. (1997) Das initiale kraniale CT zur Beurteilung der Prognose des Schädel-Hirn-Traumas. Unfallchirurg 100: 705–710

    Article  PubMed  CAS  Google Scholar 

  15. Mohanty SK, Thompson W, Rakower S (1991) Are CT scans for head injury patients always necessary? J Trauma 31: 801–804; discussion 804–805

    Article  PubMed  CAS  Google Scholar 

  16. National Institute For Health and Clinical Excellence (2003) CG4 Head Injury: Full guideline

  17. Oertel M, Kelly DF, McArthur D et al. (2002) Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg 96: 109–116

    PubMed  Google Scholar 

  18. Rieger J, Linsenmaier U, Pfeifer KJ, Reiser M (2002) Radiologische Diagnostik beim akuten Schädel-Hirn-Trauma. Radiologe 42: 547–555

    Article  PubMed  CAS  Google Scholar 

  19. Ruchholtz S, Waydhas C, Aufmkolk M et al. (2001) Interdisziplinares Qualitatsmanagement in der Behandlung schwerverletzter Patienten. Validierung eines QM-Systems fur den diagnostischen und therapeutischen Ablauf der fruhklinischen Versorgung. Unfallchirurg 104: 927–937

    Article  PubMed  CAS  Google Scholar 

  20. Servadei F, Murray GD, Penny K et al. (2000) The value of the worst computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium. Neurosurgery 46: 70–75; discussion 75–77

    Article  PubMed  CAS  Google Scholar 

  21. Stein SC, Spettell C, Young G, Ross SE (1993) Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32: 25–30; discussion 30–21

    Article  PubMed  CAS  Google Scholar 

  22. Stein SC, Young GS, Talucci RC et al. (1992) Delayed brain injury after head trauma: significance of coagulopathy. Neurosurgery 30: 160–165

    Article  PubMed  CAS  Google Scholar 

  23. Stiell IG, Wells GA, Vandemheen K et al. (2001) The Canadian CT Head Rule for patients with minor head injury. Lancet 357: 1391–1396

    Article  PubMed  CAS  Google Scholar 

  24. Valadka AB (2000) Injury to the cranium. McGraw-Hill, New York. [Diese Studie ist Teil der Doktorarbeit von Ben Ockert und wurde mit Genehmigung der Medizinischen Fakultät der Ludwig-Maximilians-Universität, München, veröffentlicht]

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland

    T. Vogel

  2. Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München, München, Deutschland

    B. Ockert, C. Kirchhoff, W. Mutschler & T. Mussack

  3. Institut für Klinische Radiologie, Klinikum der Universität München, München, Deutschland

    M. Krötz, U. Linsenmaier & K.J. Pfeifer

Authors
  1. T. Vogel
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  2. B. Ockert
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  3. M. Krötz
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  4. U. Linsenmaier
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  5. C. Kirchhoff
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  6. K.J. Pfeifer
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  7. W. Mutschler
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  8. T. Mussack
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Correspondence to T. Vogel.

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Vogel, T., Ockert, B., Krötz, M. et al. Größenprogrediente intrakranielle Blutungen nach Schädel-Hirn-Trauma. Unfallchirurg 111, 898–904 (2008). https://doi.org/10.1007/s00113-008-1502-0

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  • DOI: https://doi.org/10.1007/s00113-008-1502-0

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