Risk Factors For Deterioration In Bifrontal Contusions And Prognostic Analysis Of Surgical Intervention

Objective:To investigate the clinical and radiological factors for deterioration in bifrontal contusions and analysis prognosis of surgical intervention, providing guidance for early clinical intervention and scientific research, in order to improve prognosis in patients with double frontal cerebral contusion.Mehtods:In a retrospective study from jan 2011 to jan 2015, the clinical and radiological parameters of 87 patients identified with bifrontal contusions who initially underwent conservative treatment were systemic collected and were investigated in univariate and multivariate models to determine whether they were associated with the deterioration in therapeutic process by Logistic multifactor analysis "step by step" method. Outcomes were evaluated after trauma by using the Glasgow Outcome Scale-Extended.Results: Of 87 patients identified with bifrontal contusions,21 had experienced deterioration and 66 had remained stable. Univariate analysis indicated that the difference between subdural hematoma on admission CT, edema of cerebral contusion> the bilateral ventricle anterior angle、the ratio between anteroposterior diameter and transversal diameter of brainstem on the mesencephalon level、cerebral contusion hematoma/edema ranging over the bilateral sphenoid ridge line、the width of basal cisterns wing on follow-up CT were statistical significance(P<0.05).Multivariate analysis indicated that the bilateral ventricle anterior angle>120°(P=0.020),the ratio between anteroposterior diameter and transversal diameter of brainstem on the mesencephalon level>1.1 (P=0.003), the width of basal cisterns wing<0.5mm (P<0.001) on follow-up CT were independent risk factors for leading to the occurrence of deterioration.8 patients (38.1%) experienced early deterioration (≤48 h), while 13 patients went through delayed degradation (>48h). Age, GCS score at admission and subdural hematoma on admission CT were found significant difference between the early (≤ 48) and delayed (>48h) deterioration group (P<0.05) Furthermore, there was no significant difference in GOSE score between the deterioration group and the stable group, the early (≤48) and delayed (>48h) deterioration group (P>0.05)Conclusion:The bilateral ventricle anterior angle>120°, the ratio between anteroposterior diameter and transversal diameter of brainstem on the mesencephalon level>1.1, the width of basal cisterns wing< 0.5mm on follow-up CT are risk factors for deterioration in patients with bifrontal contusions who initially treated conservatively. Patients with age older than 60 years, admission GCS score higher than eight points, complicated with subdural hematoma prone to early deterioration. Timely detecting deterioration and early surgical intervention is beneficial to prognosis.