Choi Jae H, Jakob Michael, Stapf Christian, Marshall Randolph S, Hartmann Andreas, Mast Henning
Department of Neurology, BG Kliniken Bergmannstrost, Halle, Germany.
J Trauma. 2008 Nov;65(5):1028-35. doi: 10.1097/TA.0b013e31815eba9b.
To determine the effect of brain lesion pattern on early recovery after severe traumatic brain injury (TBI).
In a setting of a multimodal early rehabilitation unit at a level I trauma center, 135 consecutive survivors of severe TBI (mean age, 40 years, 25% women) were studied prospectively. Assessment of disability was performed weekly using an extended Barthel Index (eBI) ranging from -325 to +100 points. Clinical and brain morphologic variables were tested in multivariate logistic regression models to determine predictors of outcome.
Imaging revealed cerebral contusion in 115 patients (85%) affecting the frontal (n = 80), temporal (n = 62), parieto-occipital (n = 17), brain stem (n = 13), and cerebellar (n = 5) regions. In addition, 80 patients (59%) showed diffuse brain edema, 75 (55%) subarachnoid, 37 (28%) subdural, and 18 (13%) epidural hemorrhage. After a mean stay of 72 +/- 51 days in the early rehabilitation unit, one patient died, 40 (30%) revealed good outcome (median eBI, +55), and a further 43 patients (32%) showed excellent outcomes (eBI, 90-100). Temporal (odds ratio 2.6; 95% confidence interval 1.1-6.5) and brain stem contusions (odds ratio 13.8; 95% confidence interval 3.0-64.1) were independent predictors of poor outcome.
Temporal and brain stem contusions constitute independent risk factors for poor outcome in survivors of severe TBI. The results further suggest a high potential for multimodal early rehabilitation after severe TBI.
确定脑损伤模式对重度创伤性脑损伤（TBI）后早期恢复的影响。
在一级创伤中心的多模式早期康复单元中，对135例重度TBI连续幸存者（平均年龄40岁，25%为女性）进行前瞻性研究。每周使用范围为-325至+100分的扩展Barthel指数（eBI）进行残疾评估。在多变量逻辑回归模型中测试临床和脑形态学变量，以确定预后的预测因素。
影像学显示115例患者（85%）有脑挫裂伤，累及额叶（n = 80）、颞叶（n = 62）、顶枕叶（n = 17）、脑干（n = 13）和小脑（n = 5）区域。此外，80例患者（59%）出现弥漫性脑水肿，75例（55%）蛛网膜下腔出血，37例（28%）硬膜下出血，18例（13%）硬膜外出血。在早期康复单元平均住院72±51天后，1例患者死亡，40例（30%）预后良好（eBI中位数为+55），另有43例患者（32%）预后极佳（eBI为90 - 100）。颞叶挫裂伤（比值比2.6；95%置信区间1.1 - 6.5）和脑干挫裂伤（比值比13.8；95%置信区间3.0 - 64.1）是预后不良的独立预测因素。
颞叶和脑干挫裂伤是重度TBI幸存者预后不良的独立危险因素。结果进一步表明重度TBI后多模式早期康复具有很大潜力。
