Prognostic significance of age in traumatic brain injury.
Prognostic significance of age in traumatic brain injury.
复制标题
年龄对创伤性脑损伤的预后意义。
DOI：
10.4103/0976-3147.98208
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发表时间：
2012-05
影响因子：
1.4
通讯作者：
Mahapatra A
中科院分区：
文献类型：
--
作者：
Dhandapani S;Manju D;Sharma B;Mahapatra A
年龄是创伤性脑损伤（TBI）后的一个强有力的预后因素，其差异定义了关键的预后年龄阈值。本研究旨在确定不同年龄阈值对TBI后结局的影响。前瞻性研究TBI患者的年龄与损伤方式、格拉斯哥昏迷评分（GCS）、CT分类和手术干预的关系。在1个月时评估死亡率，在6个月时评估神经系统结局。进行了适当的统计分析（详见文章）。在入选的244例患者中，分别有144例重度TBI、38例中度TBI和62例轻度TBI。年龄与损伤程度、CT分型、手术方式有关（P < 0.01）。1个月时死亡率与年龄增长显著相关，1个月时死亡的患者中，年龄< 18岁的患者为15%，年龄在18 - 59岁之间的患者为44%，年龄> 59岁的患者为52%（P < 0.001）。不良结局与年龄的增加有显著相关性，每10年（P < 0.001）。在多变量分析中，在以40岁为中心的年龄组中，不利结局的几率逐步增加，与混杂因素无关。30岁、40岁和50岁年龄阈值的不利结局调整后优势比分别为11.3、53.3和1171（P < 0.005）。此外，根据GCS和手术干预，在所有亚组中，年龄> 40岁与不良结局显著相关（P < 0.05）。在TBI患者中，年龄与6个月时的不良结局呈独立相关，以40岁为阈值，以逐步方式进行。
Age is a strong prognostic factor following traumatic brain injury (TBI), with discrepancies defining the critical prognostic age threshold. This study was undertaken to determine the impact of various age thresholds on outcome after TBI. The ages of patients admitted with TBI were prospectively studied in relation to mode of injury, Glasgow coma score (GCS), CT category and surgical intervention. Mortality was assessed at 1 month, and neurological outcome was assessed at 6 months. Appropriate statistical analyzes (details in article) were performed. Of the total 244 patients enrolled, 144 patients had severe, 38 patients had moderate and 62 patients had mild TBI, respectively. Age had significant association with grade of injury, CT category and surgical intervention (P < 0.01). Mortality at 1 month was significantly associated with increasing age with patients dead at 1 month being 15% for age < 18, 44% for age between 18 and 59 years, and 52% in the age group > 59 years respectively (P < 0.001). Unfavorable outcome showed significant association with an increase in age, every decade (P < 0.001). In multivariate analysis, there was stepwise increase in the odds of unfavorable outcome across age groups centered on 40 years, independent of confounding factors. The adjusted odds ratios for unfavorable outcome with regard to age thresholds 30, 40 and 50 years were 11.3, 53.3 and 1171, respectively (P < 0.005). Moreover, there was significant association of unfavorable outcome with age > 40 years in all subgroups, based on GCS and surgical intervention (P < 0.05). In patients with TBI, age demonstrates independent association with unfavorable outcome at 6 months, in stepwise manner centered on a threshold of 40 years.