Preditores de mortalidade em pacientes neurocirúrgicos após trauma cranioencefálico
DOI:
https://doi.org/10.22290/jbnc.v32i4.1987Palavras-chave:
Lesões cerebrais traumáticas, Neurocirurgia, Escala de Coma de Glasgow, Análise de sobrevivênciaResumo
Introdução: O traumatismo cranioencefálico (TCE) é considerado importante causa mundial de mortalidade e morbidade. Objetivo: Avaliar de forma independente os fatores na admissão hospitalar e durante a internação que predizem mortalidade intra-hospitalar em pacientes com TCE submetidos a neurocirurgia. Métodos: Coorte retrospectiva com análise de dados de pacientes submetidos à neurocirurgia devido ao TCE. Os fatores preditores avaliados foram idade, sexo, Escala de Coma de Glasgow (ECG) na admissão, sequelas antes e depois da neurocirurgia, mecanismo de trauma e procedimento neurocirúrgico. As análises de sobrevivência foram verificadas. Valores preditivos positivos e negativos foram calculados. Resultados: Foram analisados 312 pacientes, a maioria do sexo masculino (81,4%) com TCE leve (55,8%), e com média de idade de 49,6 ± 23,5 anos. A ECG na admissão foi um preditor independente de mortalidade (HR = 0,87; IC 95%: 0,81 a 0,93; p <0,001). O GCS ≤ 13 foi o valor de corte ideal para prever a sobrevivência com uma diferença significativa entre os grupos ECG (≤13 ou> 13; p <0,001). Pacientes com ECG ≤ 13 tiveram risco seis vezes maior de mortalidade (HR 6,04; IC95 2,39 a 15,3; p <0,001). Os valores preditivos positivo e negativo foram 35,8% e 97%, respectivamente. Conclusões: A ECG na admissão é importante preditor de mortalidade hospitalar em pacientes com TCE que necessitam de procedimento neurocirúrgico.
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