Institute of Clinical Medicine, School of Medicine, National Cheng-Kung University, Southern Taiwan University, Tainan, Taiwan.
J Formos Med Assoc. 2011 Apr;110(4):258-64. doi: 10.1016/S0929-6646(11)60038-7.
Although several prognostic factors for traumatic brain injury (TBI) have been evaluated, a useful predictive scoring model for outcome has yet to be developed for TBI patients. The aim of this study was to determine independent predictors and develop a multivariate logistic regression equation to determine prognosis in TBI patients.
A total of 13 different variables were evaluated. All 84 patients in this study were retrospectively evaluated between October 2003 and January 2008 and all underwent craniectomy or craniotomy for hematoma removal and were fitted with intracranial pressure (ICP) microsensor monitors. By using univariate, multiple logistic regression and prognostic regression scoring equations it was possible to draw Receiver-Operating Characteristic curves (ROC) to predict Glasgow Outcome Scale (GOS) 6 months after TBI.
We found that patients over 40 years of age (p < 0.001), unresponsive pre-op pupil reaction (p =0.001), pre-op midline shift (p =0.008), higher injury severity score (ISS; p=0.007), and craniectomy (p < 0.05) were associated with poor outcome in patients with TBI. Using ROC curve to predict the probability of unfavorable outcome, the sensitivity was 97.5% and the specificity was 90.7%.
In our preliminary findings, five variables to predict poor outcomes 6 months after TBI were useful. These sensitive variables can be used as a referential guideline in our daily practice to decide whether or not to perform advanced management or avoid decompressive craniectomy.
尽管已经评估了几种创伤性脑损伤（TBI）的预后因素，但尚未为 TBI 患者开发出有用的预测评分模型。本研究旨在确定独立的预测因素，并建立多元逻辑回归方程来确定 TBI 患者的预后。
共评估了 13 个不同的变量。本研究中的 84 例患者均为回顾性评估，时间为 2003 年 10 月至 2008 年 1 月，所有患者均因血肿清除而行开颅术或颅骨切除术，并配备颅内压（ICP）微传感器监测仪。通过单变量、多变量逻辑回归和预后回归评分方程，可以绘制受试者工作特征曲线（ROC），以预测 TBI 后 6 个月的格拉斯哥预后量表（GOS）。
我们发现，年龄超过 40 岁的患者（p < 0.001）、术前无反应的瞳孔反应（p = 0.001）、术前中线移位（p = 0.008）、更高的损伤严重程度评分（ISS；p = 0.007）和开颅术（p < 0.05）与 TBI 患者的不良预后相关。使用 ROC 曲线预测不良结局的概率，敏感性为 97.5%，特异性为 90.7%。
在我们的初步研究结果中，有五个预测 TBI 后 6 个月不良结局的变量是有用的。这些敏感变量可作为我们日常实践中的参考指南，以决定是否进行高级管理或避免减压性颅骨切除术。
