Kemp Clinton D, Johnson J Chad, Riordan William P, Cotton Bryan A
Department of Surgery/Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee 37212, USA.
Am Surg. 2008 Sep;74(9):866-72.
Although nonneurologic organ dysfunction (NNOD) has been shown to significantly affect mortality in subarachnoid hemorrhage, the contribution of NNOD to mortality after severe traumatic brain injury (TBI) has yet to be defined. We hypothesized that NNOD has a significant impact on mortality after severe TBI. The trauma registry was queried for all patients admitted between January 2004 and December 2004 who died during their initial hospitalization after severe TBI (head Abbreviated Injury Score 3 or greater). Cause of death and contributing factors to mortality were determined by an attending trauma surgeon from the medical record. The data were analyzed using both Fisher's exact and Wilcoxon rank sum. One hundred thirty-five patients met inclusion criteria. Sixty-seven per cent were males, 83 per cent were white, and the mean age was 38.5 years. Mean length of stay was 2.9 days. Fifty-four patients (40%) had isolated TBI (chest Abbreviated Injury Score = 0, abdominal Abbreviated Injury Score = 0). Of the 81 deaths attributed to a single cause, 48 (60%) patients died from nonsurvivable TBI or brain death, whereas 33 (40%) died of a nonneurologic cause. Cardiovascular and respiratory dysfunction (excluding pneumonia) contributed to mortality in 51.1 per cent and 34.1 per cent of patients, respectively. NNOD contributes to approximately two-thirds of all deaths after severe TBI. These complications occur early and are seen even among those with isolated head injuries. These findings demonstrate the impact of the extracranial manifestations of severe TBI on overall mortality and highlight potential areas for future intervention and research.
虽然非神经器官功能障碍（NNOD）已被证明会显著影响蛛网膜下腔出血患者的死亡率，但NNOD对重度创伤性脑损伤（TBI）后死亡率的影响尚未明确。我们假设NNOD对重度TBI后的死亡率有显著影响。查询了创伤登记处2004年1月至2004年12月期间收治的所有在重度TBI（头部简明损伤评分3分或更高）后首次住院期间死亡的患者。主治创伤外科医生根据病历确定死因和死亡相关因素。使用Fisher精确检验和Wilcoxon秩和检验对数据进行分析。135名患者符合纳入标准。其中67%为男性，83%为白人，平均年龄为38.5岁。平均住院时间为2.9天。54名患者（40%）为单纯TBI（胸部简明损伤评分=0，腹部简明损伤评分=0）。在81例归因于单一原因的死亡病例中，48例（60%）患者死于无法存活的TBI或脑死亡，而33例（40%）死于非神经原因。心血管和呼吸功能障碍（不包括肺炎）分别导致51.1%和34.1%的患者死亡。NNOD导致重度TBI后约三分之二的死亡。这些并发症出现较早，甚至在单纯头部受伤的患者中也可见到。这些发现证明了重度TBI的颅外表现对总体死亡率的影响，并突出了未来干预和研究的潜在领域。
