Yusuke Katayama1, Tetsuhisa Kitamura2, Kosuke Kiyohara3, Junya Sado2, Tomoya Hirose4,5, Tasuku Matsuyama6, Takeyuki Kiguchi7, Jotaro Tachino4, Shunichiro Nakao4, Yutaka Umemura4,8, Yuko Nakagawa4, Takeshi Shimazu4. 1. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan. orion13@hp-emerg.med.osaka-u.ac.jp. 2. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan. 3. Department of Food Science, Faculty of Home Economics, Otsuma Women's University Tokyo, 12, Sanban-cho, Chiyoda-ku, Tokyo, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan. 5. Emergency and Critical Care Center, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka, Japan. 6. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Hiroko-ji noboru, Kawaramachi-dori, Kamigyo-ku, Kyoto, Japan. 7. Kyoto University Health Services, Yoshida-honmachi, Sakyo-ku, Kyoto, Japan. 8. Department of Emergency and Critical Care, Osaka General Medical Center, 3-1-56, Bandai-Higashi, Sumiyoshi-ku, Osaka, Japan.
Abstract
PURPOSE: Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. METHODS: This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. RESULTS: Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]). CONCLUSIONS: In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.
PURPOSE:Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among traumapatients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. METHODS: This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included traumapatients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. RESULTS: Among 60,390 head injurypatients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]). CONCLUSIONS: In this population of traumapatients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.
Entities:
Keywords:
Burr hole surgery in emergency department; Cerebrospinal fluid leakage; Decompressive craniectomy; Posttraumatic meningitis
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