Predictors of outcome in severely head-injured children
Predictors of outcome in severely head-injured children
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严重头部受伤儿童的结果预测因素
DOI：
10.1097/00003246-200103000-00011
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发表时间：
2001
影响因子：
8.8
通讯作者：
D. Nichols
中科院分区：
文献类型：
--
作者：
J. White;Zareen M. Farukhi;C. Bull;J. Christensen;T. Gordon;C. Paidas;D. Nichols
目的确定与儿童重型颅脑损伤患儿的生存和儿科重症监护病房(PICU)住院时间相关的急诊期变量。设计回顾队列。设置1级儿科创伤中心。儿童(0-17岁)1991年至1995年因非穿透性脑损伤入院，格拉斯哥昏迷量表≤评分为8分。对136例患者入院前72小时的测量和主要结果进行了详细分析。主要终点是生存；次要终点是PICU LOS、费用和格拉斯哥昏迷评分为≥14的日期。结果提取了预测预后的因素，包括儿科创伤评分、格拉斯哥昏迷评分、儿科死亡风险、生理变量、脑损伤的计算机断层扫描证据和神经复苏药物。病死率为24%。两组间年龄和性别相似(p≥.1)。生存由6小时格拉斯哥昏迷评分(优势比[OR]4.6；95%可信区间[CI]2.06-11.9；P&t；.001)和最大收缩压(OR 1.05；95%CI 1.01-1.09；P<；.02)独立预测。当最大收缩压为≥135 mm Hg时，存活几率增加19倍(OR18.8；95%CI2.0-178.0；P<；0.01)。出院时，67%的患者有与年龄相适应的格拉斯哥昏迷评分。幸存者的平均住院费用为8,798美元：只有使用甘露醇独立预测了高成本(优势比4.9；95%可信区间1.2-19.1；p<；0.01)。对于幸存者来说，PICU LOS的中位数为2天，尽管25%的患者LOS和GT；6天。6小时格拉斯哥昏迷评分(OR 0.62；95%CI 0.48-0.80；P<；.001)和甘露醇(OR 7.9；95%CI 2.3-27.3；P<；.001)分别独立地与存活患者的LOS延长有关。结论6小时格拉斯哥昏迷评分越高，患者存活的可能性越大。调整了损伤的严重程度，存活率与最大收缩压≥135 mm Hg相关，这表明血压高于正常与改善预后相关。甘露醇的使用与LOS的延长有关，但并不能带来生存优势。我们建议对严重颅脑损伤的儿童重新评估血压指标和甘露醇的使用。
ObjectiveDetermine variables in the acute care period associated with survival and pediatric intensive care unit (PICU) length of stay (LOS) for children with severe traumatic brain injury. DesignRetrospective cohort. SettingLevel 1 pediatric trauma center. PatientsChildren (0–17 yrs) admitted 1991 to 1995 with nonpenetrating traumatic brain injury and admission Glasgow Coma Scale score of ≤8. InterventionsNone. Measurements and Main Results The first 72 hrs of hospitalization were analyzed in detail for 136 patients. The primary end point was survival; secondary end points were PICU LOS, cost, and day at which Glasgow Coma Scale score was ≥14. Predictors of outcome were abstracted, including Pediatric Trauma Score, Glasgow Coma Scale score, Pediatric Risk of Mortality, physiologic variables, computed tomography evidence of brain injury, and neuroresuscitative medications. The fatality rate was 24%. Age and gender were similar between groups (p ≥ .1). Survival was independently predicted by 6-hr Glasgow Coma Scale score (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.06–11.9;p < .001) and maximum systolic blood pressure (OR 1.05; 95% CI 1.01–1.09;p < .02). Odds of survival increased 19-fold when maximum systolic blood pressure was ≥135 mm Hg (OR 18.8; 95% CI 2.0–178.0;p < .01). By discharge, 67% of patients had an age-appropriate Glasgow Coma Scale score. Median hospital costs were $8,798 for survivors: only mannitol use independently predicted high cost (odds ratio 4.9; 95% CI 1.2–19.1;p < .01). For survivors, median PICU LOS was 2 days, although 25% had LOS >6 days. Six-hour Glasgow Coma Scale score (OR 0.62; 95% CI 0.48–0.80;p < .001) and mannitol (OR 7.9; 95% CI 2.3–27.3;p < .001) were each independently associated with a prolonged LOS among survivors. ConclusionsPatients with higher 6-hr Glasgow Coma Scale scores were more likely to survive. Adjusting for severity of injury, survival was associated with maximum systolic blood pressure ≥135 mm Hg, suggesting that supranormal blood pressures are associated with improved outcome. Mannitol administration was associated with prolonged LOS, yet conferred no survival advantage. We suggest reevaluation of blood pressure targets and mannitol use in children with severe traumatic brain injury.
影响因子：
4.1
作者：
Daniel F. Kelly;Neil A Martin;R. Kordestani;George J. Counelis;D. Hovda;M. Bergsneider;E. Shalmon;D. McBride;Dena Herman;Donald P. Becker
通讯作者：
Daniel F. Kelly;Neil A Martin;R. Kordestani;George J. Counelis;D. Hovda;M. Bergsneider;E. Shalmon;D. McBride;Dena Herman;Donald P. Becker