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1PROGNOSTIC VALUE OF CORRELATION BETWEEN CLINICAL SIGNS WITH THE
OUTCOME OF TRAUMATIC BRAIN INJURY Saidov K.J.
Saidov Komron Jumanazarovich - Assistant of the Neurosurgery, DEPARTMENT OF NEUROSURGERY, SAMARKAND STATE MEDICAL UNIVERSITY, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: Clinical manifestations were correlated with traumatic brain injury (TBI) outcomes using computer software. Neuroopthalmologic signs, motor and vital disorders had maximal prognostic values. A close correlation was found between consciousness states, PSS and TBI variants, brain lesion forms, vital and somatic disorders indicating their role as determinants of TBI outcome.
Keywords: clinical signs, TBI, correlation, prognostic, Moscow Coma Scale.
In order to solve the problem of predicting the outcomes of traumatic brain injury (TBI) unification of a large clinical material and the determination of a set of informative clinical signs has great importance. Informative value of each investigated clinical signs is determined by differences in clinical signs of its mean values and standard deviations for different outcomes, as well as its correlation with the other signs [1, 2, 3, 6, 11, 13, 14, 15].
In this study, carried out with the use of a statistical computer processing, it has been put the following tasks: 1) to reveal a correlation of individual outcomes of TBI with neurological symptoms and state of consciousness in the affected people in a large number of observations, 2) to determine the relationship between the outcome and severity of the patients' condition, assessed by the use of a scale point assessment of the condition and the state of consciousness according to the Moscow Coma Scale, and various forms of TBI, and 3) to explore and describe the meaning of mean and standard deviation of some clinical signs to predict the outcomes of TBI [4, 5, 7, 8, 9, 10].
The study is based on the materials of the unified survey of 320 patients with TBI who were hospitalized and treated at the Clinic of Neurosurgery of Samarkand Medical Institute, as well as 91 patients who were treated in the Samarkand regional trauma center. 331 patients suffered from closed TBI, 42 patients suffered from an open non-penetrating TBI and 38 patients suffered from open penetration TBI. The largest numbers of cases (73,5%) were patients with severe brain contusion.
State of consciousness of the affected patients has been evaluated in dynamics according to the uniform classification of disturbance of consciousness with the use of Moscow coma scale developed by A.R. Shakhnovich and A.M. Mamadaliev. The data craniography, echoencephalography, computer tomography have been used to verify the various forms of TBI [8, 9, 10, 11, 12].
Clinical and series instrumental data (in general 70 signs) of these 411 patients at the age from 1 to 87 years old (343 males and 68 female) were used to examine the issues of predicting outcomes and the effectiveness of treatment of TBI in acute period by statistical processing on the computer. Patients were distributed into four groups depending on the outcomes, among which it has been detected the death outcome (DO), rude neurological disorders (RND), mild neurological disorders (MND) and restoration of function to the compensated condition (CC).
The study of correlations of different features that define the state of consciousness, and two quantitative scales that characterize the state of consciousness and severity of the patients' condition, as well as the correlation of these factors with the outcomes of TBI have been given us the possibility to obtain data to assess the prognostic significance of clinical signs.
The high correlation of using scales of states of consciousness and PSS with the outcome of TBI is an important fact testifying about the prevailed importance them in order to predict the outcomes of TBI among all investigated clinical signs (separate neurological signs, the type and severity of TBI, vital disorders, etc.).
As it is known, along with the state of consciousness and neurological symptoms the great importance for the outcome of has the type of TBI and form of brain damage, focal neurological and vital disorders. The analysis of their correlations with the state of consciousness and PSS in the different days of the acute period of TBI show the close relationship between the state of consciousness, and the severity of the condition and forms of brain damage (r = 0,440,51), intracranial hematomas (r = 0,31-0,36). In addition, it has been observed the correlations of the values for 5 days with the following features: body temperature (r = 0,33-0,40), with a frequency of breathing and self-managed or moderated breathing (r = 0,21-0,34), with convulsions of the hemispheric or stem origin (r = 0,26-0,34), with anisocoria (r = 0,26-0,3) and with an offset of M-echoes (r = 0,26-0,38).
Based on the dynamics of change in correlations with the state of consciousness and PSS in different days after the trauma can be stated as follows: the maximum correlations with the frequency of breathing spontaneously breathing or IVL and body temperature observed in the first days after the trauma, then to the 5th day they are decreased, in contrast, the occurrence of pneumonia has a maximum correlation to the 5th day, as soon as the correlation between the state of consciousness, pneumonia and PSS for all 5 days is quite high (r=0,21-0,50).
Conclusions:
1. The analysis of the correlations of the separated neurological symptoms with the outcome of TBI demonstrates their high predictive value, moreover the neuroophthalmological symptoms have a leading role (especially the opening of the eyes for the sound or pain, reaction of pupils to light, the preservation of corneal reflexes, bilateral fixed mydriasis), then disorders in the movement sphere (movement or reaction to pain and muscle atonia) and vital disorders.
2. The high correlation the scales of states of consciousness and PSS in patients with the outcome of TBI which we used demonstrate about the high importance of them for predicting the outcome of TBI than all investigated clinical signs.
3. The duration of coma and duration of the impaired consciousness have significant correlations with the outcome of TBI and, therefore, significantly affect to the outcome of TBI: the more their duration, the worse the outcome, and vice versa.
4. It has been determined the close connection between the state of consciousness, PSS and types of brain damage, vital and somatic disorders. This shows not only the interdependence of these signs, but also its essential importance for the outcome of TBI.
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