Epidemiology, Severity Classification, and Outcome of Moderate and Severe Traumatic Brain Injury: A Prospective Multicenter Study
Epidemiology, Severity Classification, and Outcome of Moderate and Severe Traumatic Brain Injury: A Prospective Multicenter Study
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DOI：
10.1089/neu.2011.2034
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发表时间：
2011-10-01
影响因子：
4.2
通讯作者：
Vos, Pieter E.
中科院分区：
文献类型：
--
作者：
Andriessen, Teuntje M. J. C.;Horn, Janneke;Vos, Pieter E.
创伤性脑损伤(TBI)患者的人口统计学、治疗方法和治疗方法的变化需要定期评估流行病学特征、损伤严重程度分类和结果。这项前瞻性多中心研究提供了508名中到重度脑外伤患者的脑损伤相关变量的详细信息。流行病学和结果的可变性通过将我们的队列与以前的多中心研究进行比较来检验。此外，还研究了在不同时间点评估的损伤严重程度分级与预后的关系。根据急诊科格拉斯哥昏迷评分(GCS)，339名患者被归类为重度创伤，129名患者为中度创伤。在15%的病例中，以事故现场GCS进行分类时，诊断不一致。如果在两个时间点都诊断为重型脑外伤(44%)，而在一个或两个时间点诊断为中度脑损伤(7-15%，p<；0.001)，则住院死亡率更高。此外，以意识损害阈值(6h)作为重型颅脑损伤的标准时，14%的患者改变了诊断：意识损害持续6h时，住院死亡率为5%。这表明，联合多种临床评估和使用意识损害阈值可能会改善损伤严重程度的分类和预后预测。与早期的多中心研究相比，我们的队列显示出不同的病例组合，包括更高的年龄(平均=47.3岁)，更广泛的(创伤性昏迷数据库I-II)损伤(58%)，以及更多的重大颅外损伤(40%)，重型(46%)和中度(21%)脑外伤的6个月死亡率相对较高。我们的结果证实，近年来，脑损伤的流行病学和损伤模式发生了变化，但病死率仍然很高。
Changes in the demographics, approach, and treatment of traumatic brain injury (TBI) patients require regular evaluation of epidemiological profiles, injury severity classification, and outcomes. This prospective multicenter study provides detailed information on TBI-related variables of 508 moderate-to-severe TBI patients. Variability in epidemiology and outcome is examined by comparing our cohort with previous multicenter studies. Additionally, the relation between outcome and injury severity classification assessed at different time points is studied. Based on the emergency department Glasgow Coma Scale (GCS), 339 patients were classified as having severe and 129 as having moderate TBI. In 15%, the diagnosis differed when the accident scene GCS was used for classification. In-hospital mortality was higher if severe TBI was diagnosed at both time points (44%) compared to moderate TBI at one or both time points (7-15%, p < 0.001). Furthermore, 14% changed diagnosis when a threshold (6 h) for impaired consciousness was used as a criterion for severe TBI: In-hospital mortality was < 5% when impaired consciousness lasted for < 6 h. This suggests that combining multiple clinical assessments and using a threshold for impaired consciousness may improve the classification of injury severity and prediction of outcome. Compared to earlier multicenter studies, our cohort demonstrates a different case mix that includes a higher age (mean = 47.3 years), more diffuse (Traumatic Coma Databank [TCDB] I-II) injuries (58%), and more major extracranial injuries (40%), with relatively high 6 month mortality rates for both severe (46%) and moderate (21%) TBI. Our results confirm that TBI epidemiology and injury patterns have changed in recent years whereas case fatality rates remain high.