Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury.
Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury.
复制标题
DOI：
10.1155/2018/3769418
复制
发表时间：
2018
影响因子：
1.7
通讯作者：
Leenen LPH
中科院分区：
文献类型：
--
作者：
Jochems D;van Wessem KJP;Houwert RM;Brouwers HB;Dankbaar JW;van Es MA;Geurts M;Slooter AJC;Leenen LPH
创伤性脑损伤（TBI）仍然是死亡的主要原因。如果预期恢复到可接受的生活质量的可能性很小，则可以开始停止生命维持治疗（WLST）。本研究的目的首先是调查中重度孤立性TBI患者的WLST率，其次是评估幸存者组的结局数据。 进行了一项回顾性队列研究。纳入了2011年至2015年期间在一家学术医院ICU住院的年龄≥ 18岁的中度或重度孤立性TBI患者。排除标准为孤立性脊髓损伤和转诊至其他医院。收集的数据包括人口统计学、死亡率、死亡原因、WLST和3个月后的格拉斯哥结局量表（GOS）评分。良好的功能结果被定义为GOS > 3。 在367例患者中，179例患者在应用入选和排除标准后入选。55例（33%）在入院期间死亡，其中45例（82%）在WLST后死亡。与未接受WLST的患者相比，接受WLST的患者年龄更大，神经功能表现更差，放射学异常更多。40%的患者在入院当天决定停止维持生命治疗。在这些患者中，有33%的患者是在急诊室时做出的决定。71%的幸存者在三个月后有良好的功能结局。没有病人离开医院与无反应觉醒综合征（UWS）或遭受UWS后三个月。1例患者在出院后3个月内死亡。 孤立性脑损伤患者的住院死亡率为33%。绝大多数人在决定停止维持生命的治疗后死亡。无患者因无反应觉醒综合征而出院。
Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included. Exclusion criteria were isolated spinal cord injury and referrals to and from other hospitals. Gathered data included demographics, mortality, cause of death, WLST, and Glasgow Outcome Scale (GOS) score after three months. Good functional outcome was defined as GOS > 3. Of 367 patients, 179 patients were included after applying inclusion and exclusion criteria. 55 died during admission (33%), of whom 45 (82%) after WLST. Patients undergoing WLST were older, had worse neurological performance at presentation, and had more radiological abnormalities than patients without WLST. The decision to withdraw life-sustaining treatment was made on the day of admission in 40% of patients. In 33% of these patients, this decision was made while the patient was in the Emergency Department. 71% of survivors had a good functional outcome after three months. No patient left hospital with an unresponsive wakefulness syndrome (UWS) or suffered from UWS after three months. One patient died within three months of discharge. In-hospital mortality in isolated brain injured patients was 33%. The vast majority died after a decision to withdraw life-sustaining treatment. None of the patients were discharged with an unresponsive wakefulness syndrome.