Extracranial injuries are important in determining mortality of neurotrauma
Extracranial injuries are important in determining mortality of neurotrauma
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DOI：
10.1097/ccm.0b013e3181e2ccd8
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发表时间：
2010-07-01
影响因子：
8.8
通讯作者：
Rao, Sudhakar
中科院分区：
文献类型：
--
作者：
Ho, Kwok M.;Burrell, Maxine;Rao, Sudhakar
目的：本研究旨在评估颅外损伤对神经创伤6个月和9年死亡率的意义。设计：回顾性数据队列研究。背景：西澳大利亚一家主要的神经创伤中心。患者：683名成年神经创伤患者。测量和主要结果：首次使用数据来验证国际上发表的最大的神经创伤“扩展”死亡率预测模型，在该模型中，如果患者入院时有低氧血症或低血压，颅外损伤被认为是重要的。采用Logistic和Cox回归方法，结合Bootstrap技术对过度拟合进行调整，分别评估创伤严重程度评分在决定6个月和9年死亡率方面的意义。在1994至2002年间收治的683例患者中，636例(93.1%)有颅外损伤。国际神经创伤“扩展”死亡率预测模型在应用于我们的患者时，校准很差，低估了观察到的死亡率(校准曲线的斜率和截距分别为2.14和0.35)。将损伤严重程度评分纳入到模型中改进了其校准。损伤严重程度评分占变异性的11%，是决定6个月死亡率的第三重要因素，仅次于马歇尔计算机断层扫描分级(17.8%)和瞳孔反应性(14.5%)。在随访6个月(19.2%)和24个月(25.8%)之间，死亡率有显著增加。结论：入院时的低血压和低氧血症不足以作为颅外损伤的标志；将损伤严重程度评分更全面地评估颅外损伤，作为标准的神经学预后因素，提高了对神经创伤后死亡率预测的准确性。(Crit Care Med 2010；38：1562-1568)
Objective: This study aimed to assess the significance of extracranial injuries, as measured by Injury Severity Score, on 6-mo and 9-yr mortality of neurotrauma.Design: Retrospective linked data cohort study.Setting: A major neurotrauma center in Western Australia.Patients: Six hundred eighty-three adult neurotrauma patients.Measurements and Main Results: Data were first used to validate the largest published international neurotrauma "extended" mortality prognostic model, in which extracranial injuries are considered significant if the patient has hypoxemia or hypotension on admission. Logistic and Cox regression, incorporating bootstrap techniques to adjust for overfitting, were used to assess the significance of Injury Severity Score in determining 6-mo and 9-yr mortality, respectively. Among a total of 683 patients admitted between 1994 and 2002, 636 (93.1%) had extracranial injuries. The international neurotrauma "extended" mortality prognostic model was poorly calibrated and underestimated the observed mortality (slope and intercept of the calibration curve were 2.14 and 0.35, respectively) when applied to our patients. Incorporating Injury Severity Score into the model improved its calibration. Injury Severity Score accounted for 11% of the variability and was the third most important factor after Marshall computed tomographic grading (17.8%) and pupil reactivity (14.5%) in determining 6-mo mortality. There was a notable increase in mortality between 6-mo (19.2%) and 24-mo follow-up (25.8%). Injury Severity Score remained important and accounted for 9.2% of the variability in determining 9-yr mortality after the injury.Conclusions: Hypotension and hypoxemia on admission were inadequate markers of extracranial injuries; incorporating more comprehensive extracranial injury assessment by the Injury Severity Score to the standard neurologic prognostic factors improved the accuracy of predictions on mortality after neurotrauma. (Crit Care Med 2010; 38:1562-1568)