The Clinical Differences of Patients With Traumatic Brain Injury in Plateau and Plain Areas

Abstract

ObjectiveTraumatic brain injury (TBI) is a leading cause of death and disability, which tends to have a worse clinical recovery if it occurs in plateau areas than in plain areas. To explore the underlying cause of this outcome preliminarily, this retrospective study was conducted to compare the clinical differences of patients with TBI in plateau and plain areas.MethodsIn this study, 32 patients with TBI in plateau areas (altitude ≥ 4,000 m) and 32 in plain areas (altitude ≤ 1,000 m) were recruited according to the inclusion and exclusion criteria from June 2020 to December 2021. The collected data and compared parameters include clinical features, head CT presentations and Marshall classifications, hematology profile, lipid profile, coagulation profile, and multiorgan (cardiac, liver, renal) function within 24 h of hospital admission, as well as the treatment method and final outcome.ResultsThere were no obvious differences in demographic characteristics, including gender, age, height, and weight, between patients with TBI in plateau and plain areas (all P > 0.05). Compared to patients with TBI in plain areas, the time before hospital admission was longer, heartbeat was slower, systolic blood pressure (SBP) was lower, and hospital stays were longer in patients with TBI in plateau areas (all P < 0.05). More importantly, elevated red blood cells (RBCs) count and hemoglobin (HGB) level, enhanced coagulation function, and higher rates of multiorgan (cardiac, liver, and renal) injury were found in patients with TBI in plateau areas (all P < 0.05).ConclusionPatients with TBI in plateau areas presented with altered clinical characteristics, enhanced coagulation function, and aggravated predisposition toward multiorgan (cardiac, liver, and renal) injury, compared to patients with TBI in plain areas. Future prospective studies are needed to further elucidate the influences of high altitude on the disease course of TBI.

Anesthesia management in elderly critically ill plateau area patients with severe craniocerebral injury caused by foreign body invasion: a case report

“…The low air pressure in plateau area also reduces oxygen partial pressure, which leads to hypoxia and high-altitude sickness [6]. Human alveolar oxygen partial pressure, arterial blood oxygen partial pressure, and oxygen saturation are lower than those in plain areas as a result of the decreased atmospheric oxygen partial pressure [1,3]. It is more challenging to keep the safety of anesthesia for surgical patients who live in plateau area [7].…”

“…Long-term plateau dwellers, when they go to low-altitude areas for short times, often exhibit general weakness, vertigo, insomnia, and other unpleasant symptoms [3,10,11]. Sedatives can be properly administered to patients with severe symptoms to promote sleep and lessen blood pressure changes.…”

“…Surgeons must assess the risks for such patients, including the need for surgery at a low altitude for high altitude patients, the need for accurate removal of intracranial foreign bodies without damaging the surrounding organs. The potential for massive intraoperative bleeding, septic shock, systemic in ammatory reactions, hyperlactatemia, and emergency rescue increases the di culty of surgery and anesthesia management [3,4]. Literature describing anesthesia administration in patients undergoing such surgery is limited because information on long-term, invasive surgery for severe craniocerebral injury is rare.…”

Neuroinflammation aggravated by traumatic brain injury at high altitude is reversed by L-serine via NFAT1-mediated microglial polarization

“…Traumatic brain injury (TBI) has brought a huge economic burden to society, as well as physical and mental burdens to victims and their caregivers (Wang et al, 2013;Maas et al, 2022). TBI at high altitude (HA) refers to TBI that occurs in areas above 3,000 m above sea level (HA-TBI) (Yang et al, 2022). The increase in the number of people travelling to HA for work or adventure tourism makes HA-TBI of greater concern (Yu et al, 2014).…”

Analysis on alteration of road traffic casualties in western China from multi-department data in recent decade

“…There were numerous risk factors that contribute to traffic accidents in high altitude areas, including longer steep road sections, snow blindness among drivers due to mountain snow, and fatigue during driving that occurs due to low partial pressures of oxygen ( 7 , 8 ). On the other hand, trauma injuries were more severe in high-altitude regions because of the high incidence of shock, reduced resuscitation capacity tolerance, and early occurrence of multi-organ failure ( 9 ). Furthermore, the western region accounts for 72% of the total land area.…”