McHugh Gillian S, Engel Doortje C, Butcher Isabella, Steyerberg Ewout W, Lu Juan, Mushkudiani Nino, Hernández Adrián V, Marmarou Anthony, Maas Andrew I R, Murray Gordon D
Public Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom.
J Neurotrauma. 2007 Feb;24(2):287-93. doi: 10.1089/neu.2006.0031.
We determined the relationship between secondary insults (hypoxia, hypotension, and hypothermia) occurring prior to or on admission to hospital and 6-month outcome after traumatic brain injury (TBI). A meta-analysis of individual patient data, from seven Phase III randomized clinical trials (RCT) in moderate or severe TBI and three TBI population-based series, was performed to model outcome as measured by the Glasgow Outcome Scale (GOS). Proportional odds modeling was used to relate the probability of a poor outcome to hypoxia (N = 5661), hypotension ( N = 6629), and hypothermia ( N = 4195) separately. We additionally analyzed the combined effects of hypoxia and hypotension and performed exploratory analysis of associations with computerized tomography (CT) classification and month of injury. Having a pre-enrollment insult of hypoxia, hypotension or hypothermia is strongly associated with a poorer outcome (odds ratios of 2.1 95% CI [1.7-2.6], 2.7 95% CI [2.1-3.4], and 2.2 95% CI [1.6-3.2], respectively). Patients with both hypoxia and hypotension had poorer outcomes than those with either insult alone. Radiological signs of raised intracranial pressure (CT class III or IV) were more frequent in patients who had sustained hypoxia or hypotension. A significant association was observed between month of injury and hypothermia. The occurrence of secondary insults prior to or on admission to hospital in TBI patients is strongly related to poorer outcome and should therefore be a priority for emergency department personnel.
我们确定了创伤性脑损伤（TBI）患者在入院前或入院时发生的继发性损伤（缺氧、低血压和体温过低）与伤后6个月预后之间的关系。我们对来自七项中度或重度TBI的III期随机临床试验（RCT）和三项基于TBI人群的系列研究中的个体患者数据进行了荟萃分析，以对通过格拉斯哥预后量表（GOS）衡量的预后进行建模。使用比例优势模型分别将不良预后的概率与缺氧（N = 5661）、低血压（N = 6629）和体温过低（N = 4195）相关联。我们还分析了缺氧和低血压的联合作用，并对与计算机断层扫描（CT）分类和受伤月份的关联进行了探索性分析。入院前存在缺氧、低血压或体温过低的损伤与较差的预后密切相关（优势比分别为2.1，95%可信区间[1.7 - 2.6]；2.7，95%可信区间[2.1 - 3.4]；2.2，95%可信区间[1.6 - 3.2]）。同时存在缺氧和低血压的患者比仅有一种损伤的患者预后更差。在遭受缺氧或低血压的患者中，颅内压升高的放射学征象（CT III级或IV级）更为常见。观察到受伤月份与体温过低之间存在显著关联。TBI患者在入院前或入院时发生继发性损伤与较差的预后密切相关，因此应成为急诊科人员的首要关注重点。
