ORIGINAL
Introdução: O traumatismo cranioencefálico (TCE) é um importante problema de saúde pública com elevada incidência na população economicamente ativa que está associado à alta morbimortalidade. Objetivos: Averiguar os fatores prognósticos no tratamento do TCE em um hospital terciário privado. Análise da relação entre causa do trauma, número de lesões, faixa etária, comorbidades prévias, evolução, período prévio e durante a pandemia. Metodologia: Estudo de coorte retrospectivo baseado na revisão de prontuários de vítimas de TCE, no período de janeiro 2016 a junho de 2021. Resultado: Foram avaliados 318 pacientes, sendo 135 mulheres e 183 homens. Destes, 230 sofreram quedas, 60 acidentes automobilísticos, 10 agressões físicas e 20 acidentes de outras causas. A sobrevida foi de 92%, 93%, 70% e 95%, respectivamente. Conclusão: O fator que mais interfere no prognóstico do TCE é a idade do paciente. Fatores como comorbidades prévias, número de lesões ou conduta tomada não interferiram no prognóstico. Não houve diferença entre os dois períodos – prévio e durante a pandemia em relação às principais causas. A população economicamente ativa é a que mais se envolve em acidentes automobilísticos.
Introduction: Traumatic Brain Injury (TBI) is an important public health problem, with insufficiency in the working population, which is associated with high morbidity and mortality. Objectives: To investigate the prognostic factors in the treatment of TBI in a private tertiary hospital. Perform an analysis of the relationship between trauma, number of injuries, age group, previous comorbidities, evolution – period prior to and during the pandemic. Methodology: Retrospective cohort study based on patients from the medical records of TBI patients, from January 2016 to June 2021. Result: Review evaluated 318, 135 women and 183 men. From these 230 were fall from height, 60 traffic accidents, 10 physical assaults, and 20 other causes. Survival was 92%, 93%, 70%, and 95%, respectively. Conclusion: The factor that most interferes in the prognosis of TBI is the patient’s age. Factors such as previous comorbidities, number of solutions or conducts do not affect the prognosis. There was no difference between the two periods, before and during the pandemic in relation to the main causes. The active population is the one that most involves traffic accidents.
1. Gaudêncio TG, Leão G. Leão GMoura. A epidemiologia do traumatismo crânioencefálico: um levantamento bibliográfico no Brasil. Rev Neurocienc. 2013;21(3):427-34. http://dx.doi.org/10.4181/RNC.2013.21.814.8p.
2. Mao G. Trauma cranioencefálico (TCE). Rahway; 2019. Available from: https://www.msdmanuals.com/pt-br/profissional/les%C3%B5esintoxica%C3%A7%C3%A3o/trauma-cranioencef%C3%A1lico-tce/trauma-cranioencef%C3%A1lico-tce. Accessed: 23/01/2022.
3. Barata RCB. O desafio das doenças emergentes e a revalorização da epidemiologia descritiva. Rev Saude Publica. 1997;31(5):531-7. http://dx.doi.org/10.1590/S0034-89101997000600015. PMid:9629734.
4. Pereira S, Coelho FB, Barros H. Acidente vascular cerebral: hospitalização, mortalidade e prognóstico. Acta Med Port. 2004;17(3):187-92. PMid:15929845.
5. Viacava F. Informações em saúde: a importância dos inquéritos populacionais. Cien Saude Colet. 2002;7(4):607-21. http://dx.doi.org/10.1590/S1413-81232002000400002.
6. BRASIL. Ministério da Saúde. Diretrizes de atenção à reabilitação da pessoa com traumatismo cranioencefálico. Brasília; 2015. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-772754. Accessed: 11/01/2022.
7. Mayer AR, Ling J, Mannell MV, et al. A prospective diffusion tensor imaging study in mild traumatic brain injury. Neurology. 2010;74(8):643-50. http://dx.doi.org/10.1212/WNL.0b013e3181d0ccdd. PMid:20089939.
8. Andrade AF, Paiva WS, Amorim RLO, Figueiredo EG, Rusafa E No, Teixeira MJ. The pathophysiological mechanisms following traumatic brain injury. Rev Assoc Med Bras. 2009;55(1):75-81. http://dx.doi.org/10.1590/S0104-42302009000100020. PMid:19360283.
9. Espírito Santo. Secretaria de Estado da Saúde do Espírito Santo. Atendimento ao paciente politraumatizado: diretrizes clínicas. Vitória; 2008. Available from: https://saude.es.gov.br/Media/sesa/Consulta%20P%C3%BAblica/Diretriz%20Trauma%2013%2008%20_2_.pdf. Accessed: 17/01/2022.
10. Wintermark M, Sanelli PC, Anzai Y, et al.; ACR HEAD INJURY INSTITUTE, ACR HEAD INJURY INSTITUTE. Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. J Am Coll Radiol. 2015;12(2):e1-14. http://dx.doi.org/10.1016/j.jacr.2014.10.014. PMid:25456317.
11. Simões MG, Amorim RLO. Traumatismo cranioencefálico e modelos prognósticos. J Bras Neurocir. 2018;26(1):57-67. http://dx.doi.org/10.22290/jbnc.v26i1.1303.
12. Carroll L, Cassidy JD, Peloso P, et al.; WHO COLLABORATING CENTRE TASK FORCE ON MILD TRAUMATIC BRAIN INJURY. Prognosis for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury. J Rehabil Med. 2004;36(43,Suppl):84-105. http://dx.doi.org/10.1080/16501960410023859. PMid:15083873.
13. Vale e Silva LOB, Nogueira TA, Cunha RLLS, et al. Análise das características de indivíduos com sequelas de traumatismo cranioencefálico (TCE) em um centro de referência em reabilitação (características de TCE). Rev Bras Neurol. 2018;54(2):28-33. http://dx.doi.org/10.46979/rbn.v54i2.19111.
14. Moreland B, Kakara R, Henry A. Trends in nonfatal falls and fallrelated injuries among adults aged ≥65 years: united States, 2012–2018. MMWR Morb Mortal Wkly Rep. 2020;69(27):875-81. http://dx.doi.org/10.15585/mmwr.mm6927a5. PMid:32644982.
15. Ye P, Er Y, Wang H, et al. Burden of falls among people aged 60 years and older in mainland China, 1990–2019: findings from the Global Burden of Disease Study 2019. Lancet Public Health. 2021;6(12):e907-18. http://dx.doi.org/10.1016/S2468-2667(21)00231-0. PMid:34838197.
16. Instituto Brasileiro de Geografia e Estatística. Santa Maria. Rio de Janeiro; 2022. Available from: https://cidades.ibge.gov.br/brasil/rs/santa-maria. Accessed: 12/01/2022.
17. Labib N, Nouh T, Winocour S, et al. Severely injured geriatric population: morbidity, mortality, and risk factors. J Trauma. 2011;71(6):1908-14. http://dx.doi.org/10.1097/TA.0b013e31820989ed. PMid:21537212.
18. Hukkelhoven CWPM, Steyerberg EW, Rampen AJJ, et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg. 2003;99(4):666-73. http://dx.doi.org/10.3171/jns.2003.99.4.0666. PMid:14567601.
19. Susman M, DiRusso SM, Sullivan T, et al. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma. 2002;53(2):219-24. http://dx.doi.org/10.1097/00005373-200208000-00004. PMid:12169925.
20. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54(10):1590-5. http://dx.doi.org/10.1111/j.1532-5415.2006.00894.x. PMid:17038079.
21. Kirsch MJ, Vrabec GA, Marley RA, Salvator AE, Muakkassa FF. Preinjury warfarin and geriatric orthopedic trauma patients: a case-matched study. J Trauma. 2004;57(6):1230-3. http://dx.doi.org/10.1097/01.TA.0000150839.69648.17. PMid:15625454.
22. Li J, Brown J, Levine M. Mild head injury, anticoagulants, and risk of intracranial injury. Lancet. 2001;357(9258):771-2. http://dx.doi.org/10.1016/S0140-6736(00)04163-5. PMid:11253975.
23. Alrajhi KN, Perry JJ, Forster AJ. Intracranial bleeds after minor and minimal head injury in patients on warfarin. J Emerg Med. 2015;48(2):137-42. http://dx.doi.org/10.1016/j.jemermed.2014.08.016. PMid:25440860.
24. Harris C, DiRusso S, Sullivan T, Benzil DL. Mortality risk after head injury increases at 30 years. J Am Coll Surg. 2003;197(5):711-6. http://dx.doi.org/10.1016/S1072-7515(03)00729-4. PMid:14585403.
25. Roozenbeek B, Maas AIR, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9(4):231-6. http://dx.doi.org/10.1038/nrneurol.2013.22. PMid:23443846.
26. Murray GD, Butcher I, McHugh GS, et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):329-37. http://dx.doi.org/10.1089/neu.2006.0035. PMid:17375997.
27. Waksman R, Blank D. The importance of domestic violence in times of COVID-19. Residência Pediátrica. 2020;10(2). http://dx.doi.org/10.25060/residpediatr-2020.v10n2-414.
28. Gunnell D, Appleby L, Arensman E, et al.; COVID-19 SUICIDE PREVENTION RESEARCH COLLABORATION. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020;7(6):468-71. http://dx.doi.org/10.1016/S2215-0366(20)30171-1. PMid:32330430.
29. Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019: a perfect storm? JAMA Psychiatry. 2020;77(11):1093-4. http://dx.doi.org/10.1001/jamapsychiatry.2020.1060. PMid:32275300.
30. Appleby L, Richards N, Ibrahim S, Turnbull P, Rodway C, Kapur N. Suicide in England in the COVID-19 pandemic: early observational data from real time surveillance. Lancet Reg Health Eur. 2021;4:100110. http://dx.doi.org/10.1016/j.lanepe.2021.100110. PMid:34557817.
1 Medical student, Franciscana University, Santa Maria, RS, Brazil.
2 MD, PhD, Cancerologist, Professor, Oncologic and General Surgery, ORL Head and Neck Surgery, Franciscana University, Santa Maria, RS, Brazil.
3 PhD, Mathematician, Engineer, Estatistics and operational investigation, Professor, Franciscana University, Santa Maria, RS, Brazil.
Received Oct 15, 2022
Corrected Oct 21, 2022
Accepted Oct 28, 2022
