De Silva Mary J, Roberts Ian, Perel Pablo, Edwards Phil, Kenward Michael G, Fernandes Janice, Shakur Haleema, Patel Vikram
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
Int J Epidemiol. 2009 Apr;38(2):452-8. doi: 10.1093/ije/dyn189. Epub 2008 Sep 9.
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. The burden of TBI is greatest in low- and middle-income countries (LAMIC), yet little is known about patient outcomes in these settings.
Complete data on 8927 patients from 46 countries from the corticosteroid randomization after significant head injury (CRASH) trial were analysed to explore whether outcomes 6 months after TBI differed between high-income countries and LAMIC.
Just under half of patients experienced a good recovery, one-third moderate or severe disability and one-quarter died within 6 months of their injury. Univariate analyses showed that patients in LAMIC were more likely to die following severe TBI, but were less likely to be disabled following mild and moderate TBI. These results were confirmed in multivariate analyses. Compared to patients in high-income countries, patients in LAMIC have over twice the odds of dying following severe TBI (OR 2.23, 95% CI 1.51-3.30) but half the odds of disability following mild (OR 0.41, 95% CI 0.23-0.72) and moderate TBI (OR 0.53, 95% CI 0.35-0.81). There were no differences between settings in the odds of death following either mild or moderate TBI.
Reduced death rates following severe TBI in patients from high-income countries may be due to differences in medical care which may result in a higher proportion of patients surviving with a disability. Socio-cultural factors may explain the lower levels of disability after mild and moderate TBI in LAMIC.
创伤性脑损伤（TBI）是全球死亡和残疾的主要原因之一。在低收入和中等收入国家（LAMIC），TBI的负担最为沉重，但对于这些地区患者的预后情况却知之甚少。
分析了来自46个国家的8927例患者的完整数据，这些数据来自重度颅脑损伤后皮质类固醇随机试验（CRASH），以探讨高收入国家和LAMIC中TBI患者6个月后的预后是否存在差异。
略低于一半的患者恢复良好，三分之一有中度或重度残疾，四分之一在受伤后6个月内死亡。单因素分析显示，LAMIC中的患者在重度TBI后死亡的可能性更大，但在轻度和中度TBI后残疾的可能性较小。多因素分析证实了这些结果。与高收入国家的患者相比，LAMIC中的患者在重度TBI后死亡的几率高出两倍多（OR 2.23，95%CI 1.51 - 3.30），但在轻度（OR 0.41，95%CI 0.23 - 0.72）和中度TBI（OR 0.53，95%CI 0.35 - 0.81）后残疾的几率仅为一半。轻度或中度TBI后的死亡几率在不同地区之间没有差异。
高收入国家患者重度TBI后死亡率降低可能是由于医疗护理的差异，这可能导致更高比例的患者存活但伴有残疾。社会文化因素可能解释了LAMIC中轻度和中度TBI后残疾水平较低的原因。
