Artikel
Cranial nerve injuries in patients with moderate to severe head trauma – analysis of 91,196 patients from the Trauma Registry of the German Trauma Society between 2008 and 2017
Hirnnervenverletzungen bei Patienten mit moderatem bis schwerem Schädelhirntrauma – Analyse von 91.196 Patienten des TraumaRegisters der Deutschen Gesellschaft für Unfallchirurgie zwischen 2008 und 2017
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Veröffentlicht: | 4. Juni 2021 |
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Objective: Traumatic brain injury (TBI) constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries (CNI) in moderate to severe TBI is largely unknown. We aimed to determine the prevalence of CNI in TBI as well as clinical differences between TBI patients with and without concomitant CNI (CNI vs. control group) by means of a large multinational trauma registry.
Methods: The Trauma Registry of the German Trauma Society was evaluated for trauma patients with head injuries ≥2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables.
Results: 1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3±20.6 vs. 51.8±23.0 years), but did not differ regarding gender distribution (CNI 69.4%; control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p<0.01; chi-square test) and falls more commonly in the control group (45.2% vs. 37.1%; p<0.01). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p<0.01) and skull base fractures (51.0% vs. 23.5%; p<0.01). Despite similar mean Injury Severity Score (CNI 21.8±11.3; control 21.1±11.7) and Glasgow Coma Scale score (CNI 10.9±4.2, control 11.1±4.4), there was a considerably higher rate of anisocoria in CNI patients (20.1% vs. 11.2%; p<0.01). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p<0.01).
Conclusion: CNI as rare adjuncts to TBI should raise the suspicion of complicating skull base fractures and indicate higher rates of functional impairment following primary care.
Notice:TR-DGU project ID 2019-021. Data provision was carried out by TraumaRegister DGU®. Evaluation and interpretation are in the author’s responsibility and haven’t yet accomplished the review process of TraumaRegister DGU®.