Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia.
PLoS One. 2011;6(5):e20545. doi: 10.1371/journal.pone.0020545. Epub 2011 May 31.
Traumatic brain injury (TBI) remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE) guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes.
Isolated TBI admissions (>15 years, July 2005-June 2006) were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3) admissions were provided by the Trauma Audit and Research Network (TARN) and Victorian State Trauma Registry (VSTR) for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions.
Mortality was 12% (749/6256) in England/Wales and 9% (91/1048) in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5), and for cases <65 years (OR 2.36, 95% CI: 1.51, 3.69). For severe TBI, mortality was 23% (133/575) for TARN and 20% (68/346) for VSTR, with 72% of TARN and 86% of VSTR cases managed at a neurosurgical centre. The adjusted mortality odds for severe TBI cases in TARN were higher compared to the VSTR (OR 1.45, 95% CI: 0.96, 2.19), but particularly for cases <65 years (OR 2.04, 95% CI: 1.07, 3.90). Neurosurgical centre management modified the effect overall (OR 1.12, 95% CI: 0.73, 1.74) and for cases <65 years (OR 1.53, 95% CI: 0.77, 3.03).
The risk-adjusted odds of mortality for all isolated TBI admissions, and severe TBI cases, were higher in England/Wales when compared to Victoria. The lower percentage of cases managed at neurosurgical centres in England and Wales was an explanatory factor, supporting the changes made to the NICE guidelines.
创伤性脑损伤（TBI）仍然是导致死亡和残疾的主要原因。英国国家卫生与临床优化研究所（NICE）指南建议将严重 TBI 病例转至神经外科中心，无论是否需要神经外科治疗。本观察性研究调查了英格兰/威尔士和澳大利亚维多利亚州 TBI 单纯性病例入院的风险调整死亡率，并研究了神经外科中心管理对结局的影响。
从两个司法管辖区的医院出院数据集中提取 TBI 单纯性病例（>15 岁，2005 年 7 月至 2006 年 6 月）。严重 TBI 单纯性病例（AIS 严重程度>3）由创伤审核和研究网络（TARN）和维多利亚州创伤登记处（VSTR）分别提供给英格兰/威尔士和维多利亚州。采用多变量逻辑回归比较两个司法管辖区的风险调整死亡率。
英格兰/威尔士 TBI 单纯性病例入院的死亡率为 12%（749/6256），维多利亚州为 9%（91/1048）。总体而言，英格兰/威尔士的死亡调整优势比高于维多利亚州（OR 2.0，95%CI：1.6，2.5），65 岁以下病例的优势比更高（OR 2.36，95%CI：1.51，3.69）。对于严重 TBI，TARN 中的死亡率为 23%（133/575），VSTR 为 20%（68/346），72%的 TARN 和 86%的 VSTR 病例在神经外科中心接受治疗。TARN 中严重 TBI 病例的调整死亡率优势比高于 VSTR（OR 1.45，95%CI：0.96，2.19），但 65 岁以下病例的优势比更高（OR 2.04，95%CI：1.07，3.90）。神经外科中心管理改变了总体死亡率优势比（OR 1.12，95%CI：0.73，1.74）和 65 岁以下病例的死亡率优势比（OR 1.53，95%CI：0.77，3.03）。
与维多利亚州相比，英格兰/威尔士所有 TBI 单纯性病例和严重 TBI 病例的风险调整死亡率更高。英格兰和威尔士接受神经外科中心治疗的病例比例较低是一个解释因素，支持对 NICE 指南进行的更改。
