Factores clínicos y de neuroimagen asociados con el pronóstico del traumatismo craneoencefálico moderado

José Manuel Ortega Zufiría, Noemí Lomillos Prieto, Bernardino Choque Cuba, Mario Sierra Rodríguez, Pedro Poveda Núñez, Martin Tamarit Degenhardt, María Remedios López Serrano, Jorge Zamorano Fernández, Guillermo del Piñal Álvarez de Buergo

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Resumen

OBJTIVO: Determinar los principales factores clínicos y de neuroimagen asociados con el pronóstico de los enfermos con traumatismo craneoencefálico moderado.

MÉTODOS: Se realizó un estudio retrospectivo de los pacientes mayores de 14 años con traumatismo craneoencefálico moderado, atendidos en el Hospital Universitario de Getafe (Madrid) entre los años 2005 y 2015. La muestra estuvo constituida por 66 pacientes. A partir de la escala de coma de Glasgow se establecieron grupos para describir las variables clínicas y de neuroimagen asociadas con el pronóstico a corto plazo. Se determinaron las medias, los porcentajes, y se efectúo un análisis bivariable. Consecuentemente, se diseñó un esquema de actuación clínica a partir de los factores analizados.

RESULTADOS: Del total de pacientes analizados, hubo más varones con traumatismo craneoencefálico moderado (57 pacientes). El accidente de tránsito fue el mecanismo causante más significativo (33 pacientes). El deterioro neurológico clínico es más frecuente en los enfermos con lesión axonal difusa asociada a edema cerebral
y que presentan contusiones múltiples bilaterales. En el estudio multivariable (regresión lineal), la existencia o no de focalidad neurológica (coeficiente de regresión: 0,884), los hallazgos en la tomografía computarizada de control (coeficiente de regresión: 0,499), los hallazgos en la tomografía computarizada inicial (coeficiente de regresión: 0,174) y la edad (coeficiente de regresión: 0,033) fueron significativos (p<0,001) en relación con la evolución final. Con la escala de coma de Glasgow se observaron diferencias en el pronóstico entre los pacientes con puntuación de 11 y 12, y los que obtuvieron 9 y 10 puntos. Sin embargo, el total de la escala de coma no se relaciona directamente con la evolución del enfermo que presenta traumatismo craneoencefálico moderado.

CONCLUSIONES: Los factores asociados con el pronóstico de los enfermos con traumatismo craneoencefálico moderado son los hallazgos anormales en la tomografía computarizada inicial, la existencia de focalidad neurológica, la presencia de deterioro neurológico clínico, la edad avanzada, los hallazgos en la tomografía computarizada de control, y como mecanismos causantes están los atropellos, caídas e impactos directos. Consideramos que siempre es necesario el ingreso hospitalario, en función de la situación clínica y de los hallazgos patológicos en la tomografía computarizada.

Palabras clave

Escala de coma de Glasgow; Evolución final del paciente; Pronóstico; Traumatismo craneoencefálico

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