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首页> 外文期刊>American Journal of Physical Medicine and Rehabilitation >Cautionary Case Low Glasgow Coma Scale Scores, Brainstem Involvement, Decompressive Craniectomy, Full Recovery, and One More Reason for Advocacy/Collaboration
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Cautionary Case Low Glasgow Coma Scale Scores, Brainstem Involvement, Decompressive Craniectomy, Full Recovery, and One More Reason for Advocacy/Collaboration

机译：警戒性病例格拉斯哥昏迷量表评分低，脑干受累，减压颅骨切除术，完全康复以及进行辩护/协作的另一个原因

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摘要

Presurgical selection criteria for decompressive craniectomy (DC) for treatment of severe traumatic brain injury remain controversial. Proposed criteria to improve outcomes include high admission Glasgow Coma Scale scores (Q7) and exclusion of patients having brainstem involvement. Neurosurgeons may be unaware of long-term functional outcomes in their DC patients. Therefore, to underscore an exceptional outcome that may have been facilitated by DC, while highlighting need for caution in development of potentially overly restrictive presurgical selection criteria, this case report of a 21-yr-old premed college student admitted with severe traumatic brain injury, Glasgow Coma Scale score of 3, left fixed dilated pupil, and brainstem signs, who had emergency DC, is presented. Nine years after the trauma, she was employed full time as a physician, and only residual symptom, an occasional headache, remained. Thus, caution is necessary in the development of DC presurgical selection guidelines, as this case had excellent long-term functional outcome that may have been facilitated by DC despite initial low Glasgow Coma Scale scores and signs of brainstem involvement. Also, this case highlights one more reason for multispecialty physician advocacy, collaboration, and comparative effectiveness research.
机译：减压颅骨切除术（DC）治疗严重颅脑外伤的术前选择标准仍存在争议。改善结局的建议标准包括高入院格拉斯哥昏迷量表评分（Q7）和排除脑干受累患者。神经外科医生可能不知道其DC患者的长期功能结局。因此，为了强调可能由DC促成的特殊结果，同时强调在制定可能过度限制的术前选择标准时需要谨慎，该病例报告是一名21岁的预科大学生，患有严重的颅脑外伤，格拉斯哥昏迷量表评分为3，瞳孔固定，瞳孔缩小，脑干体征为急诊DC。创伤九年后，她被全职聘为医生，仅残留症状，偶有头痛。因此，在制定DC术前选择指南时必须谨慎，因为尽管最初的格拉斯哥昏迷量表评分较低且脑干受累迹象，该病例仍具有出色的长期功能结局，而DC可能已促进了这种情况。同样，此案凸显了进行多专业医师倡导，合作和比较有效性研究的另一个原因。

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