Department of Neurology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19106, USA.
Neurosurgery. 2012 May;70(5):1095-105; discussion 1105. doi: 10.1227/NEU.0b013e318240c1ed.
Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important.
To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]), and clinical outcome after severe TBI.
One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2, and outcome was examined by using mixed-effects models and logistic regression.
Median (25%-75% interquartile range) admission GCS and APACHE II without GCS scores were 3.0 (3-7) and 11.0 (8-13), respectively. Marshall and Rotterdam scores were 3.0 (3-5) and 4.0 (4-5). Mean ICP and PbtO2 during the patients' ICU course were 15.5 ± 10.7 mm Hg and 29.9 ± 10.8 mm Hg, respectively. Three-month mortality was 37.6%. Admission GCS was not associated with mortality. APACHE II (P = .003), APACHE-non-GCS (P = .004), Marshall (P < .001), and Rotterdam scores (P < .001) were associated with mortality. No relationship between GCS, ISS, Marshall, or Rotterdam scores and subsequent ICP or PbtO2 was observed. The APACHE II score was inversely associated with median PbtO2 (P = .03) and minimum PbtO2 (P = .008) and had a stronger correlation with amount of time of reduced PbtO2.
Following severe TBI, factors associated with outcome may not always predict a patient's ICU course and, in particular, intracranial physiology.
预测严重创伤性脑损伤（TBI）后的临床病程和结局非常重要。
检查临床量表（格拉斯哥昏迷量表[GCS]、损伤严重程度评分[ISS]和急性生理学和慢性健康评估 II [APACHE II]）或基于入院计算机断层扫描（Marshall 和 Rotterdam）的放射学量表是否与重症监护病房（ICU）生理学（颅内压[ICP]、脑组织氧张力[PbtO2]）以及严重 TBI 后的临床结局相关。
确定了 101 名接受 ICP 和 PbtO2 监测的严重 TBI 患者（中位年龄为 41.0 岁；四分位距[26-55]）。使用混合效应模型和逻辑回归检查入院时 GCS、ISS、APACHE II、Marshall 和 Rotterdam 评分与 ICP、PbtO2 和结局之间的关系。
中位（25%-75%四分位距）入院 GCS 和无 GCS 评分的 APACHE II 分别为 3.0（3-7）和 11.0（8-13）。Marshall 和 Rotterdam 评分分别为 3.0（3-5）和 4.0（4-5）。患者 ICU 期间的平均 ICP 和 PbtO2 分别为 15.5±10.7mmHg 和 29.9±10.8mmHg。3 个月死亡率为 37.6%。入院 GCS 与死亡率无关。APACHE II（P=.003）、APACHE-非 GCS（P=.004）、Marshall（P<.001）和 Rotterdam 评分（P<.001）与死亡率相关。未观察到 GCS、ISS、Marshall 或 Rotterdam 评分与随后的 ICP 或 PbtO2 之间存在任何关系。APACHE II 评分与中位 PbtO2（P=.03）和最小 PbtO2（P=.008）呈负相关，与 PbtO2 降低的时间量相关性更强。
在严重 TBI 后，与结局相关的因素可能并不总是预测患者的 ICU 病程，特别是颅内生理学。
