Murray Gordon D, Butcher Isabella, McHugh Gillian S, Lu Juan, Mushkudiani Nino A, Maas Andrew I R, Marmarou Anthony, Steyerberg Ewout W
Public Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom.
J Neurotrauma. 2007 Feb;24(2):329-37. doi: 10.1089/neu.2006.0035.
We studied the prognostic value of a wide range of conventional and novel prognostic factors on admission after traumatic brain injury (TBI) using both univariate and multivariable analysis. The outcome measure was Glasgow Outcome Scale at 6 months after injury. Individual patient data were available on a cohort of 8686 patients drawn from eight randomized controlled trials and three observational studies. The most powerful independent prognostic variables were age, Glasgow Coma Scale (GCS) motor score, pupil response, and computerized tomography (CT) characteristics, including the Marshall CT classification and traumatic subarachnoid hemorrhage. Prothrombin time was also identified as a powerful independent prognostic factor, but it was only available for a limited number of patients coming from three of the relevant studies. Other important prognostic factors included hypotension, hypoxia, the eye and verbal components of the GCS, glucose, platelets, and hemoglobin. These results on prognostic factors will underpin future work on the IMPACT project, which is focused on the development of novel approaches to the design and analysis of clinical trials in TBI. In addition, the results provide pointers to future research, including further analysis of the prognostic value of prothrombin time, and the evaluation of the clinical impact of intervening aggressively to correct abnormalities in hemoglobin, glucose, and coagulation.
我们采用单变量和多变量分析方法，研究了创伤性脑损伤（TBI）后入院时一系列传统和新型预后因素的预后价值。结局指标为伤后6个月时的格拉斯哥预后评分。我们获取了来自8项随机对照试验和3项观察性研究的8686例患者的个体患者数据。最有力的独立预后变量为年龄、格拉斯哥昏迷量表（GCS）运动评分、瞳孔反应以及计算机断层扫描（CT）特征，包括马歇尔CT分级和创伤性蛛网膜下腔出血。凝血酶原时间也被确定为一个有力的独立预后因素，但仅在来自3项相关研究的有限数量患者中可用。其他重要的预后因素包括低血压、低氧、GCS的眼部和言语部分、血糖、血小板及血红蛋白。这些关于预后因素的结果将为IMPACT项目的未来工作奠定基础，该项目专注于开发TBI临床试验设计和分析的新方法。此外，这些结果为未来研究提供了方向，包括进一步分析凝血酶原时间的预后价值，以及评估积极干预纠正血红蛋白、血糖和凝血异常的临床影响。
