Epidemiologic Survey Of Craniocerebral Trauma In Shandong

Objectives: Do epidemiological survey about the diagnosis and treatment status quo of CCT (craniocerebral trauma) in Shandong Province, then make research and analysis. Through EBM (evidence-based medicine) methods, the cooperation system for CCT survey was set up, the survey table was designed in order to collect the clinical epidemiology information as more as possible, including the situations at the time when CCT occurred, the incidence rate, the high risk group, the area, the time, the degree of traumas, the type, the prognosis, the diagnosis and first-aid measures, the operating modus, the drug treatments, and any other factor that can influences the prognosis of CCT, etc. As we can handle the basic date of the epidemiology survey on CCT, it's easy for us to evaluate the status quo now in Shandong, and to suggest a directory proposal for CCT care and unify the treatment standard. We believe that the situation of CCT care in Shandong, even in China, will earn benefits.Methods:1. Set up the cooperation system for the epidemiology survey on CCT in Shandong with 18 hospitals in total, including one provincial hospital, nine cityhospitals, 6 county hospitals and another 2 mining industry hospitals.2. An effective, complete and precise CCT schedule table was designed, which were filled by the special person after systemic training, in order to collect the data exactitudely.3. General information:(l)The age, gender, occupation and education degree of the patients(2)The exact time, place and reason of the CCT. If CCT occurs in a traffic accident, then the identity and state of the injury person in the traffic accident, the vehicle and reason of the accident would be recorded.(3)Field first aid: the first aid time, the first-aid measure, the participant in the first aid, the first-aid transport methods after injury and the first hospital send in.(4)Hospital first aid: the time between injury and hospitalization, the first-aid measure in the hospital, the blood pressure, blood transfusion treatment and tracheal intubation or incision.(5)Clinical manifestation: classification of the craniocerebral injury, type of the scalp injury, combined organ damage, location of injury, basal fracture, craniocerebral injury degree (GCS grade), clinical diagnosis.(6) Auxiliary examination: the finding of x-ray, CT and MRI, the time between injury and CT diagnosis, the amount of intracranial hematoma, fracture of skullcap, basal fracture, the situation of intracranial damage, CT examination and surgery intervention.(7)Hospital treatment: if operation was carried on, the time between injury and the operation, the operation style and what other operation was carried on at the same time would be recorded, and if not, we would record the situation of neurosurgery conventional therapy, prophylactic anti-epileptic therapy, monitoring facilities and environment.(8) Prognosis: complication, the infection type, the result of bacterial culture, acute psychonosema after CCT, the situation and curative effect evaluation at the discharge, GOS score and the time between injury and death, the death reason wouldalso be recorded if the one died.4. Collect the data from the CCT schedule tables and do statistic, and statistically software SPSS 11.5 was used to do statistical analysis.Results: There are 4135 cases totally acquired in this CCT epidemiologic survey of the year 2004 in Shandong. Retrospective analysis about the data, we can find that, the male cases are 3113 with 75.3 %, and females are 1022 cases at the ratio of 24.7%. The mainly age is raised from 16 to 45, and most of them are peasants (58.5%). The major causes of the CCT are traffic accident at the place mainly of common highway, taken a ratio of 61.6% and 62.3%. The average time between injury and hospitalization is 2 hours 7 mins, then 44.2% of the patients were treated with dehydrating agents, and 31.1% by debriding and saturation. 91.9% of the patients undergo a closed trauma of the head, and 95.5% of the total patients had done CT examination with a result of 43.7% intracranial hemorrhage and 39.2% fracture of the skull. 1101 cases were treated by operation at the rate of 26.6%, and there were 3718 cases treated by the routine methods of neurosurgery with dehydration and hemostasis with 89.9% in total. For curative effect evaluation, at the time when the patients went out of the hospital, there are 3313 cases at the percents of 80.1 healing well and can go well life, 391 cases for 9.5% are moderate disabled but capable of self-care, while there are 2.6% of the patients with a number of 108 cares who are severe disabled and 3.0% (122 cases) are still in a coma. Otherwise, 201 cases with 4.9% are dead. Do Logistic regression analysis with the whole data, we can find that the age, the place, the reason and the degree of the injury show huge influence on the prognosis (PO.05).Conclusion: Traffic accidents are the first reason for the incidence of CCT, and male at the age of 16-45 are the high risk persons. The age, the happened place, the reason and the degree of the injury show huge influence on the prognosis of the CCT patients. After injured, the immediate diagnosis and operation treatment highly improve the general therapeutic efficacy than before. However, in gravis type of CCT, the mortality and invalidity rate are still very high as treated only byoperation and dehydration. Compared with the developed country, we still have our shortage at the CCT care in Shandong, and we should do something at the regionalization trauma center, hospital treatment and public safety education for improvement.