孙瑾玮 1蔡武 2张雪珂 2于进超 3王黎明 3张继军 4侯洁 5张龙江1
作者信息
- 1. 徐州医科大学医学影像学院,徐州 221004||南京大学医学院附属金陵医院/东部战区总医院放射诊断科
- 2. 苏州大学附属第二医院影像科
- 3. 山东大学附属威海市立医院影像科
- 4. 阿克苏地区第一人民医院影像中心
- 5. 中国人民解放军北部战区总医院影像科
- 折叠
摘要
Abstract
Objective To investigate the association between different skull fracture sites and the occurrence and complexity of intracranial hemorrhage in patients with traumatic brain injury(TBI),and to develop CT-based risk prediction models for intracranial hemorrhage using initial head computed tomography(CT)findings.Methods In this multicenter retrospective study,4 700 TBI patients from five tertiary hospitals were enrolled.Based on the initial CT findings,patients were categorized into three groups:no intracranial hemorrhage(n=1 602),single intracranial hemorrhage(n=1 011),and multiple intracranial hemorrhages(n=2 087).Data on age,sex,scalp hematoma,midline shift,cerebral herniation,skull fracture sites,and intracranial hemorrhage types were recorded.Continuous variables were compared among groups using one-way analysis of variance(ANOVA),while categorical variables were compared using the chi-square test.Univariable analysis was used to assess the associations between skull fracture sites and various types of intracranial hemorrhage.Multivariable logistic regression was then performed to identify independent risk factors related to skull fracture sites for predicting the occurrence and complexity of intracranial hemorrhage.Prediction models for the presence/absence of intracranial hemorrhage and hemorrhage complexity were constructed accordingly,and model performance was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),calibration curves,and decision curve analysis(DCA).Results Significant differences were observed among the three groups in age,sex,scalp hematoma,midline shift,cerebral herniation,and the distribution of skull fracture sites(all P<0.05).Cranial fractures were identified as risk factors for intracranial hemorrhage,with sphenoid fractures(OR=8.35)and temporal fractures(OR=6.93)showing the strongest associations.In the model predicting the presence or absence of intracranial hemorrhage,after incorporating clinical information and specific skull fracture sites,the model achieved an AUC of 0.895(95%CI:0.89-0.90),demonstrated good calibration,and DCA indicated a high net benefit within a threshold probability range of approximately 0.10-0.60.The prediction model for multiple intracranial hemorrhages had an AUC of 0.689(95%CI:0.67-0.71),showed acceptable calibration,and retained some clinical utility within certain threshold probability ranges.Furthermore,epidural hematoma(EDH)was significantly associated with temporal and sphenoid fractures,as well as high-risk combined cranial fracture patterns(all P<0.05).Conclusion Skull fracture sites are closely associated with the occurrence and complexity of intracranial hemorrhage in TBI patients.The risk prediction models for intracranial hemorrhage,constructed based on skull fracture sites and relevant clinical information,exhibit good discriminative ability and have certain clinical decision-making value,which may serve as a reference for early risk stratification of TBI patients in the emergency department.关键词
创伤性脑损伤/颅骨骨折/颅内出血/体层摄影术,X线计算机/风险分层Key words
Traumatic brain injury/Skull fracture/Intracranial hemorrhage/Tomography,X-ray computed/Risk stratification分类
医药卫生
