Predicting survival from head trauma 24 hours after injury: A practical method with therapeutic implications
Predicting survival from head trauma 24 hours after injury: A practical method with therapeutic implications
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DOI：
10.1097/00005373-199607000-00014
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发表时间：
1996-07-01
影响因子：
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通讯作者：
Damron, S
中科院分区：
文献类型：
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作者：
Mamelak, AN;Pitts, LH;Damron, S
目的：建立一种预测颅脑损伤后长期预后的方法，并确定伤后24小时能否准确预测预后。设计：对672例昏迷患者(格拉斯哥昏迷评分小于或等于8分)昏迷至少6小时、存活24小时以上、有6个月预后数据的研究队列进行回顾性研究，采用逐步Logistic回归分析确定哪些临床变量可以预测6个月的预后，将有统计学意义的临床预测因素组合成一个单一的检查变量(MPX评分)，反映检查从最差到最好的排序，测量和主要结果：年龄、入院时和24小时的最佳运动评分和瞳孔反应性是影响预后的显著因素；眼外活动仅在24小时内可预测，年龄是最重要的独立预测因素，其次是最佳运动评分、瞳孔反应性和眼外活动，将这些预测因素结合到MPX评分中可得到一套可靠地预测长期结果的图表，24小时MPX数据是更好的预测6个月结果的指标，在预测阴性结果方面比入院数据更具体。结论：该方法简单易用，依赖于床边神经学检查和单一图表，但似乎最早在颅脑损伤后24小时就能准确地预测长期结果，如果在其他大型系列患者中得到验证，这种方法可以为终止不太可能在颅脑损伤中存活的患者的护理提供客观和实际的基础。
Objective: To develop a method to predict long-term outcome after head injury and determine if outcome can be accurately predicted 24 hours after injury.Design: A retrospective review was performed on a study cohort of 672 head-injured patients admitted in coma (Glascow Coma Scale score less than or equal to 8) who remained comatose for at least 6 hours, survived more than 24 hours, and had 6-month outcome data available, Stepwise logistic regression analysis was used to determine which clinical variables predicted 6-month outcome, Statistically significant clinical predictors were combined into a single examination variable (MPX score), which reflected a rank-ordering of examinations from worst to best, which was then further weighted by patient age, The relation between 6-month outcome and MPX score at admission and 24 hours was plotted and analyzed.Measurement and Main Results: Age, best motor score, and pupillary reactivity at admission and 24 hours were significant predictors of outcome; extraocular motility was predictive at 24 hours only, Age was the most important independent predictor, followed by best motor score, pupillary reactivity, and extraocular motility, Combining these predictors into MPX score resulted in a set of graphs that reliably predicted long-term outcome, The 24-hour MPX data were better predictors of 6-month outcome and were more specific in predicting negative outcomes than admission data,Conclusions: The method is simple to use, relying on bedside neurologic examination and a single graph, but appears to predict long-term outcome accurately as early as 24 hours after head injury, If validated on other large series of patients, this method could provide an objective and practical basis for terminating care in patients unlikely to survive a head injury.