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Schockraummanagement bei polytraumatisierten Patienten mit Schädel-Hirn-Verletzungen

Eine systematische Literaturübersicht

Emergency room management of the multiply injured patient with traumatic brain injuries

A systematic review of the literature

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Zusammenfassung

Diese Übersicht untersucht die klinische Diagnostik und notwendige Sofortmaßnahmen bei polytraumatisierten Patienten mit Schädel-Hirn-Verletzungen. Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuchen) und Klassifikation nach Evidenzgüte (Level 1–5 nach Oxforder Schema) zusammengetragen.

Eine ausführliche Literaturanalyse mit Empfehlungen wurde von der „Brain Trauma Foundation“ zu diesem Thema erarbeitet und im World Wide Web publiziert (http://www2.braintrauma.org/).

Bei Patienten mit Schädel-Hirn-Verletzungen sollten im Schockraum folgende Sofortmaßnahmen durchgeführt werden: 1. Erhebung einer genauen Anamnese, um Risikofaktoren für ein schweres SHT zu erkennen, 2. Kontrolle des „Glasgow Coma Scales“ (GCS), der Pupillenmotorik und des Blutdruckes, 3. Diagnostik mittels CT und 4. schnelle chirurgische Dekompression, sofern indiziert.

Abstract

This overview reviews the literature on multiply injured patients with traumatic brain injuries. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).

A detailed analysis of the literature of traumatic brain injuries has been elaborated by the Brain Trauma Foundation and has been published in the World Wide Web (http://www2.braintrauma.org/).

The following procedures should be performed in the emergency room for multiply injured patients with traumatic brain injuries: (1) recording of precise history to identify risk factors for severe traumatic brain injury, (2) measurement of the Glasgow Coma Scale (GCS), pupillary reflex, and mean arterial pressure, (3) diagnostic evaluation with a CT scan, and (4) rapid surgical decompression if indicated.

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Literatur

  1. Adelson PD, Bratton SL, Carney NA et al. (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med 4: 1–71

    Google Scholar 

  2. Adelson PD, Bratton SL, Carney NA et al. (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient. Pediatr Crit Care Med 4: 12–18

    Google Scholar 

  3. Alderson P, Roberts I (2000) Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev CD000196

  4. Borczuk P (1995) Predictors of intracranial injury in patients with mild head trauma. Ann Emerg Med 25: 731–736

    CAS  PubMed  Google Scholar 

  5. Braakman R, Schouten HJ, Blaauw-van Dishoeck M, Minderhoud JM (1983) Megadose steroids in severe head injury. Results of a prospective double-blind clinical trial. J Neurosurg 58: 326–330

    CAS  PubMed  Google Scholar 

  6. Bullock MR, Chesnut RM, Ghajar J et al. (2000) Surgical management of traumatic brain injury. Brain Trauma Foundation

  7. Chesnut RM, Marshall LF, Klauber MR et al. (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222

    CAS  PubMed  Google Scholar 

  8. Cohen JE, Montero A, Israel ZH (1996) Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 41: 120–122

    CAS  PubMed  Google Scholar 

  9. Cooper PR, Moody S, Clark WK, Kirkpatrick J, Maravilla K, Gould AL, Drane W (1979) Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg 51: 307–316

    Google Scholar 

  10. Dearden NM, Gibson JS, McDowall DG, Gibson RM, Cameron MM (1986) Effect of high-dose dexamethasone on outcome from severe head injury. J Neurosurg 64: 81–88

    Google Scholar 

  11. Dent DL, Croce MA, Menke PG et al. (1995) Prognostic factors after acute subdural hematoma. J Trauma 39: 36–43

    CAS  PubMed  Google Scholar 

  12. Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD (1988) High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 69: 15–23

    Google Scholar 

  13. Faupel G, Reulen H, Muller D (1976) Double -blind study on the effects of steroid on severe closed head injury. Springer, Berlin Heidelberg New York, S 337–343

  14. Gaab MR, Trost HA, Alcantara A et al. (1994) „Ultrahigh“ dexamethasone in acute brain injury. Results from a prospective randomized double-blind multicenter trial (GUDHIS). German Ultrahigh Dexamethasone Head Injury Study Group. Zentralbl Neurochir 55: 135–143

    CAS  PubMed  Google Scholar 

  15. Gabriel EJ, Ghajar J, Jagoda A, Pons PT, Scalea T, Walters BC, Brain Trauma Foundation (2002) Guidelines for prehospital management of traumatic brain injury. J Neurotrauma 19: 111–174

    Google Scholar 

  16. Ghajar J (2000) Traumatic brain injury. Lancet 356: 923–929

    Article  CAS  PubMed  Google Scholar 

  17. Giannotta SL, Weiss MH, Apuzzo ML, Martin E (1984) High dose glucocorticoids in the management of severe head injury. Neurosurgery 15: 497–501

    CAS  PubMed  Google Scholar 

  18. Grumme T, Baethmann A, Kolodziejczyk D et al. (1995) Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases. Res Exp Med (Berl) 195: 217–229

    Google Scholar 

  19. Haselsberger K, Pucher R, Auer LM (1988) Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir (Wien) 90: 111–116

    Google Scholar 

  20. Hofman PA, Nelemans P, Kemerink GJ, Wilmink JT (2000) Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry 68: 416–122

    Google Scholar 

  21. Kotwica Z, Brzezinski J (1993) Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 121: 95–99

    Google Scholar 

  22. Lee EJ, Hung YC, Wang LC, Chung KC, Chen HH (1998) Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 45: 946–952

    CAS  PubMed  Google Scholar 

  23. Lehmann U, Krettek C (2001) Multiple trauma with craniocerebral trauma. Unfallchirurg 104: 195

    Article  CAS  PubMed  Google Scholar 

  24. Marshall LF, Maas AI, Marshall SB et al. (1998) A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg 89: 519–525

    Google Scholar 

  25. Mendelow AD, Teasdale G, Jennett B, Bryden J, Hessett C, Murray G (1983) Risks of intracranial haematoma in head injured adults. Br Med J 287: 1173–1176

    CAS  Google Scholar 

  26. Miller JD, Becker DP (1982) Secondary insults to the injured brain. J R Coll Surg Edinb 27: 292–298

    CAS  PubMed  Google Scholar 

  27. Muizelaar JP, Marmarou A, Ward JD et al. (1991) Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 75: 731–739

    Google Scholar 

  28. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41: 84–94

    Article  CAS  PubMed  Google Scholar 

  29. Poon WS, Li AK (1991) Comparison of management outcome of primary and secondary referred patients with traumatic extradural haematoma in a neurosurgical unit. Injury 22: 323–325

    Article  CAS  PubMed  Google Scholar 

  30. Reilly PL, Simpson DA, Sprod R, Thomas L (1988) Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Childs Nerv Syst 4: 30–33

    CAS  PubMed  Google Scholar 

  31. Roberts I (2000) Aminosteroids for acute traumatic brain injury. Cochrane Database Syst Rev CD001527

  32. Roberts I, Schierhout G, Wakai A (2003) Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev CD001049

  33. Sakas DE, Bullock MR, Teasdale GM (1995) One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg 82: 961–955

    Google Scholar 

  34. Saul TG, Ducker TB, Salcman M, Carro E (1981) Steroids in severe head injury: A prospective randomized clinical trial. J Neurosurg 54: 596–600

    Google Scholar 

  35. Schierhout G, Roberts I (2000) Hyperventilation therapy for acute traumatic brain injury. Cochrane Database Syst Rev CD000566

  36. Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF (1984) The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol. Can J Neurol Sci 11: 434–340

    CAS  PubMed  Google Scholar 

  37. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC (1981) Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 304: 1511–1158

    CAS  PubMed  Google Scholar 

  38. Smith HP, Kelly DL, Jr., McWhorter JM, Armstrong D, Johnson R, Transou C, Howard G (1986) Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg 65: 820–824

    Google Scholar 

  39. Stiell IG, Wells GA, Vandemheen K et al. (2001) The Canadian CT Head Rule for patients with minor head injury. Lancet 357: 1391–1396

    Article  CAS  PubMed  Google Scholar 

  40. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84

    Article  CAS  PubMed  Google Scholar 

  41. Teasdale GM, Murray G, Anderson E, Mendelow AD, MacMillan R, Jennett B, Brookes M (1990) Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries. BMJ 300: 363–367

    CAS  PubMed  Google Scholar 

  42. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care. J Neurotrauma 17: 463–627

    Google Scholar 

  43. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care guidelines for cerebral perfusion pressure. J Neurotrauma 17: 507–511

    PubMed  Google Scholar 

  44. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care hyperventilation. J Neurotrauma 17: 513–520

    Google Scholar 

  45. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The Joint Section on Neurotrauma and Critical Care Indications for intracranial pressure monitoring. J Neurotrauma 17: 479–491

    Google Scholar 

  46. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care Initial management. J Neurotrauma 17: 463–469

    Google Scholar 

  47. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care intracranial pressure treatment threshold. J Neurotrauma 17: 493–495

    Google Scholar 

  48. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care resuscitation of blood pressure and oxygenation. J Neurotrauma 17: 471–478

    Google Scholar 

  49. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care role of antiseizure prophylaxis following head injury. J Neurotrauma 17: 549–553

    Google Scholar 

  50. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care role of steroids. J Neurotrauma 17: 531–535

    Google Scholar 

  51. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care trauma systems. J Neurotrauma 17: 457–462

    Google Scholar 

  52. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care use of barbiturates in the control of intracranial hypertension. J Neurotrauma 17: 527–530

    Google Scholar 

  53. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons: The joint section on neurotrauma and critical care use of mannitol. J Neurotrauma 17: 521–525

    Google Scholar 

  54. Vassar MJ, Perry CA, Holcroft JW (1993) Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. J Trauma 34: 622–33

    CAS  PubMed  Google Scholar 

  55. Vos PE, Battistin L, Birbamer G et al. (2002) EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol 9: 207–219

    Google Scholar 

  56. Whitfield PC, Patel H, Hutchinson PJ et al. (2001) Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg 15: 500–507

    Article  CAS  PubMed  Google Scholar 

  57. Wilberger JE, Harris M, Diamond DL (1991) Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 74: 212–218

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsspital, Zürich

    M. Heinzelmann & O. Trentz

  2. Neurochirurgische Klinik, Universitätsspital, Zürich

    H.-G. Imhof

  3. Klinik für Unfallchirurgie, Universitätsspital, Rämistraße 100, CH-8091, Zürich, Schweiz

    M. Heinzelmann

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  1. M. Heinzelmann
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  3. O. Trentz
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Correspondence to M. Heinzelmann.

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Heinzelmann, M., Imhof, HG. & Trentz, O. Schockraummanagement bei polytraumatisierten Patienten mit Schädel-Hirn-Verletzungen. Unfallchirurg 107, 871–880 (2004). https://doi.org/10.1007/s00113-004-0846-3

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