دورية أكاديمية
Blood Pressure Control in Traumatic Subdural Hematomas.
| العنوان: | Blood Pressure Control in Traumatic Subdural Hematomas. |
|---|---|
| المؤلفون: | Hallan DR; Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA. |
| المصدر: | Cureus [Cureus] 2022 Oct 25; Vol. 14 (10), pp. e30654. Date of Electronic Publication: 2022 Oct 25 (Print Publication: 2022). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: Palo Alto, CA : Cureus, Inc. |
| مستخلص: | Background There is debate over optimal systolic blood pressure (SBP) after traumatic subdural hematoma. Increased SBP has the benefit of increasing cerebral perfusion pressure and limiting the detrimental secondary effects of traumatic brain injury but poses a risk of hematoma expansion. While prior studies have shown that SBP<90mmHg is associated with worsened morbidity and mortality in subdural hematoma patients, clinical guidelines and expert opinion have differing initial SBP goals. The aim of this study is to leverage a large database to determine the effects of two such goals, namely SBP 100-150mmHg versus SBP<180mmHg in this patient population. Methods A de-identified database network (TriNetX Research Network) was used to retrospectively query all patients with a first instance diagnosis of acute traumatic SDH, who also had a recorded GCS, with maintenance of SBP 100-150 within the first 24 hours (cohort 1) versus patients with an SBP<180 (cohort 2). Data came from 68 health care organizations (HCOs) with a total of 105,897,964 patients on 9/1/2022. The primary outcome of interest was mortality within 30 days. Secondary outcomes include gastrostomy tube placement, craniotomy/craniectomy/burr hole drainage, venous thromboembolism, ischemic stroke, myocardial infarction, seizure, falls, cardiac arrest, and acute kidney injury within 30 days. Cohorts were propensity-score matched for confounders. Results After propensity score matching, 1,243 patients were identified in each cohort. Age at index was 57.97+/-23.21 years and 58.28+/-22.35 years for cohorts 1 and 2, respectively. Mortality was seen in 243 patients (19.756%) vs. 209 (16.992%) (OR 1.203, 95% CI (0.98,1.476), p=0.0767) in cohorts 1 and 2, respectively. There was no statistical difference in secondary outcomes. Conclusion The results of this study demonstrate that the primary outcome of mortality at 30 days is not statistically different in acute traumatic SDH patients, whether their SBP is kept at 100-150 or below 180. Likewise, it shows no statistical difference in the subsequent incidence of gastrostomy tube placement, craniotomy/craniectomy/burr holes, venous thromboembolism, ischemic stroke, myocardial infarction, seizure, falls, or acute kidney injury. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Hallan et al.) |
| References: | Lancet Psychiatry. 2021 May;8(5):416-427. (PMID: 33836148) Neurosurgery. 1988 Sep;23(3):343-7. (PMID: 3226512) World Neurosurg. 2021 May;149:e504-e511. (PMID: 33561555) J Cardiol Cases. 2018 Oct 16;19(1):25-28. (PMID: 30693055) Pediatrics. 2018 Aug;142(2):. (PMID: 30064999) Acta Neurochir Suppl. 2021;131:43-48. (PMID: 33839816) J Surg Res. 2021 Jan;257:493-500. (PMID: 32916502) J Neurotrauma. 2020 Jan 15;37(2):389-396. (PMID: 31583962) Intensive Care Med. 1999 Sep;25(9):1006-9. (PMID: 10501760) Br J Neurosurg. 1999 Apr;13(2):154-7. (PMID: 10616584) Minerva Anestesiol. 2017 Apr;83(4):412-421. (PMID: 27982555) Clin Neurol Neurosurg. 2021 Mar;202:106478. (PMID: 33454499) Semin Arthritis Rheum. 2021 Oct;51(5):1057-1066. (PMID: 34450504) Neurocrit Care. 2021 Jun;34(3):1017-1025. (PMID: 33108627) World Neurosurg. 2019 Jan 10;:. (PMID: 30639489) J Neurotrauma. 2021 Jul 15;38(14):1995-2002. (PMID: 33280492) Semin Respir Crit Care Med. 2021 Feb;42(1):127-144. (PMID: 32916746) JCO Clin Cancer Inform. 2018 Dec;2:1-10. (PMID: 30652541) Lancet Neurol. 2013 Dec;12(12):1200-10. (PMID: 24139680) EClinicalMedicine. 2021 Sep;39:101061. (PMID: 34368663) Surg Clin North Am. 2017 Oct;97(5):1015-1030. (PMID: 28958355) J Crit Care. 2018 Dec;48:243-250. (PMID: 30245365) |
| فهرسة مساهمة: | Keywords: blood pressure; map; mortality; outcomes; sbp; sdh; subdural hematoma; systolic blood pressure; tbi; traumatic brain injury |
| تواريخ الأحداث: | Date Created: 20221128 Latest Revision: 20221129 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC9685202 |
| DOI: | 10.7759/cureus.30654 |
| PMID: | 36439570 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder كن أول من يترك تعليقا!