Prognostic Factors of Outcome in Patients Undergoing Surgical Intervention following Traumatic Intracerebral Haemorrhage

Authors

  • Md Shah Newaz Assistant Registrar-Neurotrauma, Department of Neurosurgery, Chittagong Medical College Hospital
  • Md Rabiul Karim Associate Professor and Head of the Department, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram
  • Mohammad Humayun Rashid Associate Professor and Head, Department of Neurosurgery, East West Medical College Hospital, Dhaka, Bangladesh
  • SM Noman Khaled Chowdhury Professor and Ex-Head of the Department, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram
  • Mohammad Sanaullah Associate Professor, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram
  • Mahfujul Quader Associate Professor, Department of Neurospine Surgery, Chittagong Medical College Hospital, Chattogram
  • Tapas Sarker Resident Surgeon (Neurosurgery), Kurmitola General Hospital, Dhaka
  • Sirajul Munir Ohi Medical Officer, Belaichari UHC, Rangamati
  • Narayan Dhar Registrar-Neuro Trauma, Department of Neurosurgery, Chittagong Medical College Hospital, Chittagong
  • Abul Hasan Md Touhidur Reza Assistant Registrar, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram.
  • Md Kamal Hossain Assistant Registrar-Paediatric Neurosurgery, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram
  • Asiful Islam Chief Resident, Department of Neurosurgery, Department of Neurosurgery, Chittagong Medical College Hospital, Chattogram

DOI:

https://doi.org/10.3329/bjns.v13i2.74131

Keywords:

Traumatic Intracerebral haemorrhage; Prognostic factors; Surgical intervention.

Abstract

Background: Intracerebral hemorrhage is a common complication after traumatic brain injury. While it is accepted practice to remove extra-axial (extradural and subdural) haematoma following traumatic brain injury, but surgical practice in the treatment of traumatic intracerebral hemorrhage (TICH) differs widely, and prognostic factors associated with outcome following surgery have not yet been well established. Aims: The study aimed to determine the prognostic factors of outcome in patients undergoing surgical intervention following traumatic intracerebral hemorrhage in a tertiary care hospital in southeastern part of Bangladesh. Materials and Methods: This prospective interventional study included 45 patients requiring craniotomies for decompression and evacuation of an intracranial hemorrhage following traumatic intracerebral hemorrhage in the Neurosurgery Department of Chittagong Medical College Hospital between December 2021 to June 2023. Demographic features, perioperative clinical and radiological characteristics of these patients were examined in relation to favorable/good outcome, defined as Glasgow Outcome Scale (GOS) score >3 at 3months follow-up, and unfavorable/poor outcome, defined as 3months mortality or GOS score d”3 at 3months after surgery. Results: The median age was 45 (range 8-75) years, 82.2% were male, and road traffic accident was the commonest cause (73.3%). Initial loss of consciousness was found in 75.7% of patients and the median GCS on admission was 9 (Interquartile range 8-10). Craniotomy and evacuation was done in 23(51.1%) of the cases, followed by craniectomy and evacuation in 22 (48.9%)patients. In-hospital and 3 months mortality rate was 28.9%. At three months post surgery, all of the survived patients(32) had good outcomes; 29 (92.3%) had GOS scores of 5, while the remaining 3 had GOS scores of 4. In bivariate analysis, age, history of comorbidity and loss of consciousness, GCS on admission, hematoma volume, and injury to surgery interval was found to have significant association with poor outcome (p<0.05). Age (OR: 1.211, 95% CI: 1.012-1.241, p=0.009) and GCS score on admission (OR: 0.301, 95% CI: 0.086-0.827, p=0.004) were independent predictors of 3-months poor outcome or mortality in multivariate logistic regression analysis. Conclusions: This study presented that older age(60 years) and lower GCS(7-10) on admission were the independent predictors of poor outcome after 3 months of surgery. Multicenter studies are needed to provide accurate data on traumatic intracerebral hemorrhage in Bangladesh.

Bang. J Neurosurgery 2024; 13(2): 104-111

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Published

2024-10-23

How to Cite

Md Shah Newaz, Md Rabiul Karim, Mohammad Humayun Rashid, SM Noman Khaled Chowdhury, Mohammad Sanaullah, Mahfujul Quader, Tapas Sarker, Sirajul Munir Ohi, Narayan Dhar, Abul Hasan Md Touhidur Reza, Md Kamal Hossain, & Asiful Islam. (2024). Prognostic Factors of Outcome in Patients Undergoing Surgical Intervention following Traumatic Intracerebral Haemorrhage. Bangladesh Journal of Neurosurgery, 13(2), 104–111. https://doi.org/10.3329/bjns.v13i2.74131

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Original Articles