The Outcome of Severe Traumatic Brain Injury in Latin America.
The Outcome of Severe Traumatic Brain Injury in Latin America.
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DOI：
10.1016/j.wneu.2017.11.171
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发表时间：
2018-03
影响因子：
2
通讯作者：
Global Neurotrauma Research Group
中科院分区：
文献类型：
--
作者：
Bonow RH;Barber J;Temkin NR;Videtta W;Rondina C;Petroni G;Lujan S;Alanis V;La Fuente G;Lavadenz A;Merida R;Jibaja M;Gonzáles L;Falcao A;Romero R;Dikmen S;Pridgeon J;Chesnut RM;Global Neurotrauma Research Group
创伤性脑损伤（TBI）不成比例地影响中低收入国家（LMIC）。影响低收入国家结果的因素没有像高收入国家那样得到严格的审查。本研究旨在研究影响拉丁美洲LMIC TBI结局的临床和人口统计学因素。在一项严重TBI颅内压监测随机试验和一项伴随观察性研究期间前瞻性收集了数据。受试者年龄≥ 13岁，入院时GCS ≤ 8。主要结局为6个月时的格拉斯哥结局量表扩展版（GOS-E）。预测因素分析采用多变量比例优势模型逐步向前选择。550名患者被确诊。88%的患者可获得6个月的结局，其中37%的患者死亡，44%的患者GOS-E评分为5-8。在多变量比例优势建模中，更高GCS电机（OR 1.41/点，95% CI 1.23-1.61）和硬膜外血肿（OR 1.83，95%CI 1.17-2.86）是GOS-E较高的显著预测因素，而高龄（OR 0.65/10年，95% CI 0.57-0.73）和脑池消失（P <0.001）与较低的GOS-E相关。值得注意的是，研究地点（P <0.001）和种族（P = 0.004）显著预测结果，超过了临床变量，如低血压和瞳孔检查。严重TBI的死亡率在拉丁美洲LMIC是高的，虽然有利的恢复率是类似的HIC。人口统计学因素，如种族和研究地点在预测结果中发挥了巨大的作用;需要进一步的研究来了解这些关联。
Traumatic brain injury (TBI) disproportionately affects lower and middle income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries (HIC). This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥ 13 years and admitted to study hospitals with GCS ≤ 8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) at six months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. 550 patients were identified. Six month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E of 5–8. In multivariable proportional odds modeling, higher GCS motor (OR 1.41 per point, 95% CI 1.23–1.61) and epidural hematoma (OR 1.83, 95% CI 1.17–2.86) were significant predictors of higher GOS-E, whereas advanced age (OR 0.65 per 10 years, 95% CI 0.57–0.73) and cisternal effacement (P < .001) were associated with lower GOS-E. Notably, study site (P < .001) and race (P = .004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary exam. Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to HIC. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations.
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