Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V, Dessalles P H, Cazaugade M, Labadens P
Department of Anesthesia, University Hospital of Bordeaux, 33076 Bordeaux cedex, France.
J Trauma. 2001 Sep;51(3):481-9. doi: 10.1097/00005373-200109000-00010.
The aim of this prospective study was to estimate annual incidences of hospitalization for severe traumatic brain injury (TBI) (maximum Abbreviated Injury Score in the head region [HAIS] 4 or 5) in a defined population of 2.8 million.
Severe TBI patients were included in the emergency departments in the 19 hospitals of the region. A prospective data form was completed with initial neurologic state, computed tomographic scan lesions, associated injuries, length of unconsciousness, and length of stay in acute care centers. Outcome at the time the patient left acute hospitalization was retrospectively assessed from medical notes.
During the 1-year period (1996), 497 residents fulfilled the inclusion criteria, leading to an annual incidence rate of 17.3 per 100,000 population; 58.1% were HAIS5. Mortality rate was 5.2 per 100,000. Men accounted for 71.4% of cases. Median age was 44 years, with a quarter of patients more than 70 years old. Traffic accidents were the most frequent causes (48.3%), but falls accounted for 41.8% of all patients. Age and severity were different according to the major categories of external causes. In HAIS5 patients, 86.5% were considered as comatose (coma lasting more than 24 hours or leading to immediate death) but only 60.9% had an initial Glasgow Coma Scale score < 9. In the HAIS4 group, 7.2% had an initial Glasgow Coma Scale score < 9. Fatality rates were 30.0% in the whole study group, 7.7% in HAIS4, 12.8% in HAIS5 without coma, and 51.2% in HAIS5 with coma.
This study shows a decrease in severe TBI incidence when results are compared with another study conducted 10 years earlier in the same region. This is because of a decrease in traffic accidents. However, this results in an increase in the proportion of falls in elderly patients and an increase in the median age in our patients. This increased age influences the mortality rate.
这项前瞻性研究的目的是估计在280万特定人群中重度创伤性脑损伤（TBI）（头部区域最大简明损伤评分[HAIS]为4或5）的年度住院发病率。
该地区19家医院的急诊科纳入了重度TBI患者。一份前瞻性数据表格填写了初始神经状态、计算机断层扫描病变、相关损伤、昏迷时长以及在急性护理中心的住院时长。从病历中回顾性评估患者离开急性住院时的结局。
在1996年的1年期间，497名居民符合纳入标准，导致年度发病率为每10万人17.3例；58.1%为HAIS5。死亡率为每10万人5.2例。男性占病例的71.4%。中位年龄为44岁，四分之一的患者年龄超过70岁。交通事故是最常见的原因（48.3%），但跌倒占所有患者的41.8%。根据主要外部原因类别，年龄和严重程度有所不同。在HAIS5患者中，86. – 5%被认为昏迷（昏迷持续超过24小时或导致立即死亡），但只有60.9%的患者初始格拉斯哥昏迷量表评分<9。在HAIS4组中，7.2%的患者初始格拉斯哥昏迷量表评分<9。整个研究组的死亡率为30.0%，HAIS4组为7.7%，无昏迷的HAIS5组为12.8%，有昏迷的HAIS5组为51.2%。
与10年前在同一地区进行的另一项研究结果相比,本研究显示重度TBI发病率有所下降。这是由于交通事故减少。然而，这导致老年患者跌倒比例增加，且我们患者的中位年龄增加。年龄增加影响死亡率。
