Analysis Of Intracranial Hematoma Progression Of Acute Traumatic Brain Injury In Elderly Patients

Background&Objective As our country gradually enters into agingsociety, the proportion of old people among acute traumatic brain injury(TBI) patients is larger and larger by the year. After traumatic brain injury,old and young patients have lots of differences not only in clinical feature,hematoma formation and progression but also treatment and prognosisbecause of the diversity of physiology between the two groups. On anotherhand, with the spread of spiral CT examination that is very important in TBIdiagnosis, there are lots of studies about intracranial hematoma progression(ICHP) under the observation of CT, which mostly focus on influencingfactors of ICHP. Our study aim to propose appropriate suggestions intreatment strategy of old TBI patients by comparing the ICHP and itsinfluence on prognosis between the two groups, which is based on thecombination of head CT scans and clinical manifestations.Methods The medical records of TBI patients treated in neurosurgerydepartment of The Second Affiliated Hospital of Chongqing MedicalUniversity from January2006to January2011were continuously collected and retrospectively analyzed. The cases meeting requirements were selected,which afterward were divided by two groups consist of youth (16-40yearsold112cases) and aging (>60years old104cases). All the cases contain‘base CT’ that was firstly scanned by admitted into hospital and head CTscans examined by less than6h,7-12h,13-24h,25-48h,49-72h afterwards.ICHP of the cases were continuously observed: if the hematoma did notamplify, the case was defined as none ICHP; if the hematoma amplifiedwithout clinical crisis, the case was defined as ICHP type I; if the hematomaamplified with clinical crisis, the case was define as ICHP type II. Theproportion, extent, stable (or apex) durations and prognosis influences ofICHP between the two groups were compared by statistic analysis.Results Under the circumstance of none significant differences inadmission conditions between two groups, the extent of ICHP (type I/II) wasnot significantly different (P=0.19), and the proportion of ICHP (none/I&II)was different but insignificantly. The durations of ICHP were different: thestable time of type-I ICHP was24hrs after injury in young patients (88.2%)while48hrs in elderly (82.5%); the peak time of type-II ICHP was12hrsafter injury in young patients (75.0%) while24hrs in elderly (73.9%). Theprognosis influences of ICHP were compared between none ICHP cases andtype I&II: type I of youth was not significantly different (P=0.23); type II ofyouth was not significantly different (P=0.17); type I of aging was notsignificantly different (P=0.12); type II of aging was significantly different (P<0.01).Conclusion The stable (or apex) duration of ICHP in old patients wererelatively longer, so it would be necessary that continuously observation beprolonged and clinical deterioration caused by gradually amplifiedhematoma be on the alert. Routine repeat head computed tomography(RRHCT) should be checked to monitor the ICHP. The surgical indicationmight be extended in clinical practice, and lean to imageology rather thanclinical manifestation, which means surgery might be positively consideredwhen head CT scan prompts significant mass effect by intracranialhematoma. Taking aggressive treatment before clinical deterioration ifpossible may be beneficial to prognosis.