Butcher Isabella, McHugh Gillian S, Lu Juan, Steyerberg Ewout W, Hernández Adrián V, Mushkudiani Nino, Maas Andrew I R, Marmarou Anthony, Murray Gordon D
Public Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom.
J Neurotrauma. 2007 Feb;24(2):281-6. doi: 10.1089/neu.2006.0030.
We aimed to describe and quantify the relationship between cause of injury and final outcome following traumatic brain injury (TBI). Individual patient data (N = 8708) from eight therapeutic Phase III randomized clinical trials in moderate or severe TBI, and three TBI surveys were used to investigate the relationship between cause of injury and outcome, as assessed by the Glasgow Outcome Scale (GOS) at 6 months. Proportional odds methodology was applied to quantify the strength of the association and expressed as an odds ratio in a meta-analysis. Heterogeneity across studies was assessed and associations with other predictive factors explored. In a univariate analysis, a strong association between the cause of injury and long-term outcome in moderate to severe TBI patients was observed, with consistent results across the studies. Road traffic accidents (OR 0.66, 95% CI 0.60-0.73), assaults (OR 0.66, 95% CI 0.52-0.84), and injuries sustained during sporting or recreational activities (OR 0.45, 95% CI 0.28-0.71) were all associated with better outcomes than the reference category of falls. Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost.
我们旨在描述和量化创伤性脑损伤（TBI）后损伤原因与最终结局之间的关系。来自八项中度或重度TBI治疗性III期随机临床试验以及三项TBI调查的个体患者数据（N = 8708）被用于研究损伤原因与结局之间的关系，结局通过6个月时的格拉斯哥预后量表（GOS）进行评估。采用比例优势方法量化关联强度，并在荟萃分析中表示为优势比。评估了各研究之间的异质性，并探索了与其他预测因素的关联。在单变量分析中，观察到中度至重度TBI患者的损伤原因与长期结局之间存在强关联，各研究结果一致。道路交通事故（优势比0.66，95%置信区间0.60 - 0.73）、袭击（优势比0.66，95%置信区间0.52 - 0.84）以及在体育或娱乐活动中遭受的损伤（优势比0.45，95%置信区间0.28 - 0.71）与跌倒这一参考类别相比，均与更好的结局相关。发现跌倒与年龄较大以及占位性病变的发生率较高有关。在分析中对年龄进行调整后，损伤原因与结局之间的关系消失。
