RISK FACTORS OF ADVERSE OUTCOME IN THE SURGICAL TREATMENT OF ACUTE CRANIOCEREBRAL TRAUMA
OBJECTIVES Severe craniocerebral trauma (CCT) is one of the leading causes of mortality and disability and currently ranks fi rst among all types of injury by total detrimental impact posed on healthcare, social security, and economy. Identifi cation of potential risk factors leading to an adverse outcome in surgical patients with acute CCT will help to standardize measures for their prevention, to provide their timely pharmacologic correction, to reduce their adverse effects and duration, thus preventing complications and reducing the risk of adverse outcome. AIM The aim of the study was to defi ne the risk factors of adverse outcome in surgical patients with acute CCT by studying the clinical and instrumental fi ndings, and surgical treatment outcome in 1098 patients with acute CCT (time from injury to surgery did not exceed 72 hours). RESULTS Based on the study analysis, we identifi ed three groups of factors affecting the treatment outcome in patients with acute CCT: severe-risk, moderate-risk, or mild-risk factors of adverse outcome. High risk factors of adverse outcome included clinical and CT signs of acute dislocation syndrome. Moderate-risk factors were a CT-revealed acute subdural hematoma or multiple brain damage, an extent of brain damage exceeding 100 cm3, a lateral dislocation more than 10 mm, subarachnoidal or intraventricular hemorrhage, the 2nd ventriculo-cranial ratio (VCR-2) of 8 % and lower, associated severe extracranial injuries (ISS score over 40), and also factors of secondary ischemic cerebral damage (arterial hypotension and hypoxemia). Mild-risk factors of adverse outcome were the patient age of 60 and older, a perioperatively developed "malignant" refractory intracranial hypertension. The paper has discussed in detail each of the identifi ed risk factors, assessed their statistical signifi cance in relation to the outcome, taking into account their duration and effects.