Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
J Rehabil Med. 2010 May;42(5):425-36. doi: 10.2340/16501977-0566.
To systematically review which determinants, assessed within the first month after a moderate to severe traumatic brain injury, predict 6-month functional outcome.
Databases were searched for relevant publications between 1995 and August 2008. Selection criteria were: prospective cohort studies; determinants associated with functional outcome 6 months after moderate to severe traumatic brain injury in adult patients; determinants assessed within the first month post-injury. Two reviewers independently performed the selection and quality assessment. A best- evidence synthesis was performed for prognostic factors assessed in 2 or more studies.
Twenty-eight studies were included, 27 of which were high quality. Most studies used the Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome at 6 months was found for the Glasgow Coma Scale (GCS), GCS admission, motor score, midline shift on computed tomography scan, subdural haematoma and pulsatility index. Strong evidence of no association was found for gender and intraventricular haemorrhage. For other determinants, inconclusive or no evidence was found.
GCS, GCS on admission, motor score, midline shift, subdural haematoma and pulsatility index predicted outcome 6 months after traumatic brain injury. Gender and intraventricular haemorrhage did not have predictive value.
系统回顾伤后 1 个月内评估的哪些因素可预测 6 个月时的功能结局。
检索 1995 年至 2008 年 8 月间的相关文献。选择标准为：前瞻性队列研究；与成人中度至重度创伤性脑损伤后 6 个月时功能结局相关的预测因素；伤后 1 个月内评估的预测因素。两名评价者独立进行选择和质量评价。对 2 项或更多研究评估的预后因素进行最佳证据综合。
共纳入 28 项研究，其中 27 项研究质量较高。大多数研究将伤后 6 个月时的格拉斯哥结局评分作为结局测量指标，有时也结合其它结局测量指标。格拉斯哥昏迷评分（GCS）、入院时 GCS、运动评分、计算机断层扫描的中线移位、硬膜下血肿和搏动指数对预测 6 个月时结局有强有力的证据；性别和脑室内出血与结局无关联的证据较强。其它因素的研究证据则为不确定或无证据。
GCS、入院时 GCS、运动评分、中线移位、硬膜下血肿和搏动指数可预测创伤性脑损伤后 6 个月的结局。性别和脑室内出血对结局无预测价值。
