Bali Medical Journal (BMJ) 2012.
Volume 1.
Number 1:29- 31 ISSN.
Risk Factors for Neuroworsening of Moderate Head Injury Cases in Emergency Department Sanglah General Hospital Bali-Indonesia Sasongko.
, 1Niryana.
, and 1Golden.
Surgery Department.
Faculty of Medicine Udayana University/Sanglah General Hospital.
Bali-Indonesia Objectives: To determine risk factors such as hypoxia, hypotension, age >40 years old, amount of focal lesion, low GCS upon arrival, and female associated with neuroworsening of moderate head injury cases.
Method: The study was a cohort study on 152 cases of moderate head injury admitted in Surgery Department/Udayana University Faculty of Medicine/Sanglah General Hospital from April 2010 Ae March 2011.
The variables were analyzed using multiple logistic regression model .
<0.
Results: The multivariate analysis showed age group Ou40 years old {OR 4,490 (CI 95%: 1,750 Ae 11,.
p=0,.
, male sex {OR 2,276 (CI 95%: 0,810 Ae 6,.
p=0,.
, initial GCS 9-12 {OR 2,905 (CI 95%: 0,097 Ae 24,.
p=0,.
, hypoxia {OR 13,582 (IK 95%: 4,315 Ae 42,.
p=0,.
, hypotension {OR 5,179 (CI 95%: 1,097 Ae 24,.
p=0,.
, and multiple focal lesion {OR 5,674 (CI 95%: 2,008 Ae 16,.
p=0,.
were risk factors for neuroworsening in moderate head injury cases.
Area Under Curve value was 84.
7% from the Receiver Operator Curve.
Conclusions: This study showed that hypoxia, multiple focal lesion, age Ou40 years old, and hypotension were risk factors for neuroworsening in moderate injury cases.
Keywords: Moderate head injury, neuroworsening, risk factors.
INTRODUCTION
In developing countries including Indonesia, incidence rate of head injury is high.
Prognosis of head injury is good, more than 90% of patients with head injury undergoing repair.
1 Some of the literature and research conducted focused to assess or predict the outcome of head injury from mild to severe, however, only few studies conducted to observe the development of mild head injury.
2,3 We predict that the risk factors associated with outcome of mild head injury are also risk factors for the occurrence of this mild head injury exacerbations.
4-8 Therefore in this study, the authors want to determine if the mild head injury patient with the above risk factors associated with deterioration of clinical and radiological METHODS AND PATIENTS This is a prospective cohort study of 152 mild head injury patients conducted during the period April 2010 - March 2011 at Emergency Room Sanglah General Hospital Bali-Indonesia.
Patients who are diagnosed as head injury were evaluated and accounted for risk factors related to age and sex, hypotension, hypoxia, and whether they have sedative drug.
CT scan was applied as soon as the patient in stable condition and intracranial lesions including the type and location was recorded.
Correspondence: Sasongko.
Address: Surgery Department.
Faculty of Medicine.
Udayana University/Sanglah General Hospital.
Bali-Indonesia.
Open access: w.
Medikamentosa treatment was applied to all patients and then recorded.
Follow up was carried out for 3 days and treated with O2 and head up 30A.
When, before 2 days there was an exacerbations observed indicate with a decrease of GCS more than 2 point, another CT Scan was applied to evaluate intracranial condition.
Therefore, evaluation was carried out for exacerbations as decrease of CGS and changes of CT Scan.
The data were then analyzed using SPSS 17.
for Windows to determine the risk factors of mild head injury, including age, gender, hypotension, hypoxia, intracranial lesion type and initial GCS.
Multivariate regression tests were employed to obtain the require results.
Statistical tests performed to the level of significance based on the value of p <0.
Results data were then presented in tables and graphs.
RESULTS
During research period, there were 152 patients meet inclusion criteria.
A number of 114 .
subjects were man and 38 .
0%) subjects were Age range of 16 Ae 39 years is 108 .
patients, between 40 Ae 65 years is 44 .
Patients with 9-12 point score of initial GCS during onset is 121 .
6%), with 13point score of GCS is 31 .
4%).
Patients with hypoxia are 34 .
4%) and without hypoxia are 118 .
6%).
Mainly, the patients are not in hypotension which were around 139 .
4%) and the rest 13 .
6%) were In addition, based on CT Scan patients with single focal lesion are 50 .
9%) and with ISSN.
Bali Medical Journal (BMJ) 2012.
Volume 1.
Number 1:29- 31 multipkle focal lesions are 102 .
1%).
In summary, all data were presented on Table 1.
Table 1 Characteristic of Patients Characteristic Sexes:
Ages 16-39 years 40-65 years Initial GCS 9-12 point 13 point Hypoxia with hypoxia without hypoxia Hypotension with hypotension without hypotension Focal Lessions Exacerbations no exacerbations Results 114 .
Association between dependent and independent variables were then analysed by applying multiple logistic regresion.
Multiple regression analysis reveals that sexes variable on second step were exluded as a risk factor.
On the other hand, for other five variables were included and have a role on worsening of mild head injury.
Odd ratios for these five variables were 13.
58 for hypoxia, 5.
67 for focal lession, 5.
18 for hypotension, 4.
49 for age groups, 91 for initial GCS.
Association quality of these five variables was detrmined by evaluating the ROC Then, in this study it was obtained that the value of AUC was 0.
7%) which means there was a strong association among five variables tomards the occurrence of worsening mild head
DISCUSSION