College of Nursing, Sungshin Women's University, Seoul, Korea.
J Clin Nurs. 2011 Jun;20(11-12):1518-32. doi: 10.1111/j.1365-2702.2010.03618.x. Epub 2011 Mar 31.
To review, systematically, factors contributing to outcomes in patients with traumatic brain injury.
Traumatic brain injury is a leading cause of death and disability. Several studies have determined the significant predictors of outcomes after traumatic brain injury. The comprehensive identification of these reliable factors for traumatic brain injury is critical to both clinical practice and research.
Systematic literature review.
Eligible studies that combined at least two variables to predict outcomes in patient with traumatic brain injury were identified via electronic database searches, footnote chasing and contact with clinical experts. Quality of selected studies was assessed in terms of internal and external validity using 15 questions. Two reviewers independently examined titles, abstracts and whether each met the predefined inclusion criteria.
A total of 46 studies which met review criteria were finally selected. Most studies satisfied internal validity in terms of validity of research variables and multivariate analysis, but few were validated externally. The following factors were significantly associated with unfavourable outcomes: sociodemographic factors such as older age, male gender, lower level of education; clinical factors such as lower Glasgow Coma Scale score, injury caused by motor vehicle crash, hypotension, hypoxia, increased intracranial pressure, no pupil reaction, hypo- or hyperglycaemia, anaemia, coagulopathy, hypo- or hyperthermia, abnormal level of electrolytes, duration of coma; higher level of computed tomography classification by Marshall category; type of intracerebral lesions.
Further studies on integrating the sociodemographic factors, the course of the clinical condition and a unified CT scoring system, are recommended for the evaluation and improvement of the prognosis of traumatic brain injury.
A systematic review of factors contributing to outcome for patients with traumatic brain injury will be invaluable in triage criteria, injury prognostication, care and discharge planning, resource use and patient and family counselling.
系统回顾创伤性脑损伤患者结局的影响因素。
创伤性脑损伤是死亡和残疾的主要原因。多项研究已经确定了创伤性脑损伤后结局的显著预测因素。全面识别这些可靠的创伤性脑损伤因素对于临床实践和研究都至关重要。
系统文献回顾。
通过电子数据库搜索、脚注追踪和与临床专家联系，确定了将至少两个变量结合起来预测创伤性脑损伤患者结局的合格研究。使用 15 个问题评估所选研究的内部和外部有效性。两名审查员独立检查标题、摘要以及每个研究是否符合预定义的纳入标准。
最终选择了 46 项符合审查标准的研究。大多数研究在研究变量和多变量分析的有效性方面满足了内部有效性标准，但很少有外部验证。以下因素与不良结局显著相关：社会人口学因素，如年龄较大、男性、受教育程度较低；临床因素，如格拉斯哥昏迷评分较低、机动车事故引起的损伤、低血压、低氧血症、颅内压升高、瞳孔无反应、低血糖或高血糖、贫血、凝血功能障碍、低或高热、电解质水平异常、昏迷持续时间；马歇尔分类的 CT 分级较高；脑内病变类型。
建议进一步研究整合社会人口学因素、临床病情过程和统一的 CT 评分系统，以评估和改善创伤性脑损伤的预后。
系统回顾创伤性脑损伤患者结局的影响因素，对于分诊标准、损伤预后预测、护理和出院计划、资源利用以及患者和家属咨询都将非常有价值。
