Risk Factors Of Secondary Subdural Effusion After Decompressive Craniectomy For Severe Traumatic Brain Injury

Objective:The aim of this study was to analyze the related risk factors of secondary subdural effusion in patients with sTBI after DC,so as to provide a theoretical basis and reference for the prevention and treatment of subdural effusion in patients with sTBI after DC.Methods:The medical records and imaging data of 234 patients with sTBI admitted to the Department of Neurosurgery,Local People’s Hospital from July 2017 to June 2021 were retrospectively collected.According to the relevant inclusion and exclusion criteria,a total of 204 patients with sTBI were enrolled in this study.According to the presence or absence of subdural effusion after DC,patients enrolled were divided into subdural effusion group and non-subdural effusion group.The incidence of subdural effusion in patients with sTBI after DC was calculated.SPSS 23.0 was used to analyze the clinical data of the two groups of patients,and the influencing factors with significant differences were included in multivariate Logistic regression analysis to screen the independent risk factors of secondary subdural effusion in patients with sTBI after DC.The predictive value of these risk factors for subdural effusion was analyzed.Results:Of the 204 patients with sTBI,75 developed secondary subdural effusion after DC,with an incidence rate of 36.76%.Univariate analysis found that there was no statistically significant difference between the two groups in terms of gender,age,intraventricular hemorrhage,frontal contusion,temporal contusion,EDH,basal cistern compression,preoperative pupil change,operation time,diameter of bone flap,height of bone flap,postoperative GOS score,and postoperative pulmonary infection(P>0.05).However,there were statistically significant differences in midline shift≥10 mm,SDH,intracerebral hematoma,SAH,cortical incision,cerebral hernia,preoperative GCS score,DC asymmetry,operative blood loss,distance from bone flap edge to midline ≤2cm,area of bone window,and postoperative intracranial infection(P<0.05).Multivariate analysis results showed that midline shift≥10 mm,SAH,cortical incision,low preoperative GCS score,distance from bone flap edge to midline ≤2cm,and postoperative intracranial infection were independent risk factors of secondary subdural effusion in patients with sTBI after DC,VIF<3.A prediction model for secondary subdural effusion in patients with sTBI after DC was constructed based on logistic regression analysis.The AUC,95%CI,Youden index and critical value of the constructed model were 0.894,0.843-0.933,0.671 and 0.387.The sensitivity and specificity of this model to predict secondary subdural effusion were 82.67%and 84.50%.Conclusion:In this study,75(36.76%)of 204 patients with sTBI develop subdural effusion after DC.Multivariate logistic regression analysis finds that midline shift≥10 mm,SAH,cortical incision,low preoperative GCS score,and the distance from bone flap edge to midline ≤2cm,and postoperative intracranial infection are independent risk factors for secondary subdural effusion in patients with sTBI after DC.The sensitivity,specificity and AUC of the prediction model constructed based on related risk factors are 82.67%,84.50%and 0.894.