H©matomes c©r©braux post-traumatiques et h©morragie progressive a Kinshasa : ©tude des facteurs de risque clinico-scanographiques.
Résumé
RESUME
Introduction : Lâaugmentation de la taille de lâh©matome par h©morragie progressive (HP) est une cause de la morbi-mortalit© des traumatismes cr¢nio-enc©phaliques (TCE). Le but de cette ©tude ©tait dâ©valuer, au scanner initial, les param¨tres clinico-scanographiques associ©es aux h©matomes susceptibles de pr©dire une h©morragie progressive (HP).          Â
M©thodes : il sâagissait dâune ©tude r©trospective, de 2006  2010, de 221 h©matomes c©r©braux progressifs. Les ©l©ments cliniques (¢ge, GCS) et scanographiques (fracture, h©morragie m©ning©e, h©morragie intra-ventriculaire, ?d¨me, pneumenc©phalie) ont ©t© ©tudi©s.                                                                                    Â
R©sultats : Le risque de d©velopper une HP dans le groupe des patients avec HSD et HIC ©tait de 3,5 fois en pr©sence de fracture de la vo»te (OR=3,495 ; p= 0,0019). Ce risque ©tait multipli© par 5 chez les patients avec fracture de la base. Dans le groupe des patients avec HSD, le risque ©tait de 8,8 fois en cas de fracture de la vo»te (OR=8,8 ; p=0,0001). Dans le groupe des patients avec HIC, les patients avec la FV avaient 4,92 fois le risque de faire une HP. Lâ¢ge sup©rieur  40 ans et un GCS < 8 ©taient des facteurs de risque dâh©morragie progressive.                                   Conclusion : Les patients avec h©matomes c©r©braux post-traumatiques avaient le risque de d©velopper une HP en pr©sence des fractures de la vo»te ou de la base du cr¢ne. Ce risque ©tait plus ©lev© dans le groupe des patients avec HIC et HSD et chez les patients dont lâ¢ge ©tait sup©rieur  40 ans et le GCS inf©rieur  8.Â
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SUMMARY
Introduction: The increase of hematoma size by progressive hemorrhage (PH) is one of the causes of head trauma morbi-mortality. The purpose of this study was the early CT-Scan assessment of clinical-computed tomographic parameters associated with progressive hemorrhage predictors. Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
Methods: It was a retrospective study of 221 patients with progressive cerebral hematoma between 2006 and 2010. Clinical parameters such as age, GCS and computed tomography diagnosis of fracture, subarachnoid hemorrhage, intraventricular hemorrhage, oedema, intracerebral air, have been studied. Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
Results:  The risk of developing a PH in the group of patients with subdural hematoma  (SDH) and intracerebral hematoma (ICH) was 3.5 times higher in case of the cranial vault fracture (OR=3,495; p=0,0019). The risk was 5 times higher in patients with cranial base fracture. Among patients with SDH, the risk was 8,8 times higher in case of cranium vault fracture (OR=8,8; p=0,0001). Among patients with ICH, the risk of those with vault fracture was 4,92 times higher to have PH. Age above 40 years and a GCS <8 were risk factors of PH.
Conclusion: The patients with post-trauma cerebral hematoma had high risk of developing PH in case of cranium vault or base fractures. The risk was higher in the group of patients with ICH and SDH and those whose age was above 40 years and the GCS<8.Â
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