泌尿道感染為預測老年頭部嚴重外傷預後差指標的研究
盧致誠1,2 林憲雄１ 林嘉禾１ 邱毅平１ 范文宙１ 鄭哲舟１
１奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科
２國立中正大學 資訊管理研究所
Urinary tract infection as a detrimental factor for poor outcome of older adults with severe head injury
Chih-Cheng Lu1,2, Chian-Shiung Lin1, Chia-Ho Lin1, Yi-Ping Chiu1, Wen-Chou Fan1, Tse-Chou Cheng1
１Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan
2Department of Management Information System, National Chung Cheng University, Chiayi
Purpose:
The data for long term follow-up after severe head injury is sparse. This study explored the outcome of elderly adults with severe head injury after one year.
Materials and Methods:
A secondary data analysis was used in the study. Data was collected from the hospital medical information system, the disease classification system, traumatic statistics, with or without brain surgery and patient medical records of a regional teaching hospital diagnosed with severe head injuries, were included in the study. Patients and families were followed with telephone contact one year after discharge.
Results:
Patients who were 65 and older, diagnosed with severe head injury (Injury Severity Score >= 16) were included. One hundred and forty-two patients were collected with 88 men (62%) and 54 women (38%). The mean age was 76.6 (SD = 6.6). Head trauma was caused by traffic accidents for 73 patients (51.4%) and by falls for 69 patients (48.6%). Among the subjects, 122 experienced subdural hematoma, 82 intracranial hemorrhage, 71 subarachnoid hemorrhage, and 11 epidural hemorrhage. Forty-one patients (28.9%) had simple head injury and 101 patients had multiple head injuries. The mean Glasgow Coma Scale score was 5.4 (SD=1.9), and the mean Injury Severity Score was 24.3 (SD=9.2). Thirty-eight patients (26.8%) refused surgery and 104 patients (73.2%) underwent brain surgery. Among 142 patients, 70 (49.3%) died and 72 (50.7%) survived, with 16 patients (11.3%) classified as having good prognosis and 126 (88.7%) as having poor prognosis. Complications of documented urinary tract infections for analysis showed that 15 patients with urinary tract infections and all with poor prognosis (100%, x2 =7.9, p =0.01).
Conclusion:
In this study, elderly adults who underwent head surgery had higher survival rates, and 27.6% (16/58) of those who survived were able to live independently after one year. Urinary tract infection is a significant predicting factor for the poor outcome of older adults with severe head injury. Preventing urinary tract infection is critical for elderly patients with severe head injury.