Clinical Epidemiology of Adults With Moderate Traumatic Brain Injury.
Clinical Epidemiology of Adults With Moderate Traumatic Brain Injury.
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DOI：
10.1097/ccm.0000000000002991
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发表时间：
2018-05
影响因子：
8.8
通讯作者：
Vavilala MS
中科院分区：
文献类型：
--
作者：
Watanitanon A;Lyons VH;Lele AV;Krishnamoorthy V;Chaikittisilpa N;Chandee T;Vavilala MS
描述中度创伤性脑损伤患者的入院模式、治疗和结局。回顾性队列研究。国家创伤数据库。2007年至2014年国家创伤数据库中中度创伤性脑损伤（TBI ICD 9代码和入院格拉斯哥昏迷量表评分为9-13）的成人（年龄> 18岁）。没有。人口统计学，损伤机制，医院的过程中，和设施的特点进行了检查。采用多变量Poisson回归模型分析与出院结局相关的入院特征。在114，066例患者中，大多数为白色（62%）、男性（69%），中位入院GCS 12（IQR 10-13）。77%的人患有孤立性TBI。脑震荡占中度TBI的25%，是最常见的TBI诊断。14%接受机械通气，66%进入重症监护室。超过50%的人在社区医院接受治疗。7%的人死亡，32%的人预后不良，包括GCS 13的人。与18-44岁的患者相比，45-64岁的患者发生不良结局的可能性是2倍（aRR 1.97; 95% CI 1.92-2.02），80岁以上的患者发生不良结局的可能性是5倍（aRR 4.66; 95% CI 4.55-4.76）。出院结果不佳的患者更可能在入院时有低血压（aRR 1.10; 95% CI：1.06-1.14），入院GCS较低（aRR 1.37; 95% CI：1.34-1.40）、ISS较高（aRR 2.97; 95% CI：2.86-3.09）和多发伤（aRR 1.05; 95% CI：1.02-1.07）。许多中度TBI患者病情恶化，需要神经重症监护，结果不佳。迫切需要优化这一弱势群体患者的护理和结果。
To characterize admission patterns, treatments and outcomes among patients with moderate traumatic brain injury. Retrospective cohort study. National Trauma Data Bank. Adults (age > 18 years) with moderate traumatic brain injury (TBI ICD 9 codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014. none. Demographics, mechanism of injury, hospital course, and facility characteristics were examined. Admission characteristics associated with discharge outcomes were analyzed using multivariable Poisson regression models. Of 114,066 patients, most were white (62%), male (69%), and had median admission GCS 12 (IQR 10-13). Seventy-seven percent had isolated TBI. Concussion, which accounted for 25% of moderate TBI, was the most frequent TBI diagnosis. Fourteen percent received mechanical ventilation and 66% were admitted to intensive care unit. Over 50% received care at a community hospital. Seven percent died and 32% had a poor outcome, including those with GCS 13. Compared to patients 18-44 years, patients 45-64 years were twice as likely (aRR 1.97; 95% CI 1.92-2.02), and patients over 80 years were five times as likely (aRR 4.66; 95% CI 4.55-4.76) to have a poor outcome. Patients with a poor discharge outcome were more likely to have had hypotension at admission (aRR 1.10; 95% CI: 1.06-1.14), lower admission GCS (aRR 1.37; 95% CI: 1.34-1.40), higher ISS (aRR 2.97; 95% CI: 2.86-3.09), and polytrauma (aRR 1.05; 95% CI: 1.02-1.07), compared to those without poor discharge outcomes. Many patients with moderate TBI deteriorate, require neurocritical care, and experience poor outcomes. Optimization of care, and outcomes for this vulnerable group of patients are urgently needed.