Leitgeb J, Mauritz W, Brazinova A, Majdan M, Janciak I, Wilbacher I, Rusnak M
Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Eur J Trauma Emerg Surg. 2013 Jun;39(3):285-92. doi: 10.1007/s00068-013-0269-3. Epub 2013 Mar 5.
To analyse the association between the Glasgow Coma Scale (GCS) score at intensive care unit (ICU) discharge and the 1-year outcome of patients with severe traumatic brain injury (TBI).
Retrospective analysis of prospectively collected observational data.
Between 01/2001 and 12/2005, 13 European centres enrolled 1,172 patients with severe TBI. Data on accident, treatment and outcomes were collected. According to the GCS score at ICU discharge, survivors were classified into four groups: GCS scores 3-6, 7-9, 10-12 and 13-15. Using the Glasgow Outcome Scale (GOS), 1-year outcomes were classified as "favourable" (scores 5, 4) or "unfavourable" (scores <4). Factors that may have contributed to outcomes were compared between groups and for favourable versus unfavourable outcomes within each group.
Of the 538 patients analysed, 308 (57 %) had GCS scores 13-15, 101 (19 %) had scores 10-12, 46 (9 %) had scores 7-9 and 83 (15 %) had scores 3-6 at ICU discharge. Factors significantly associated with these GCS scores included age, severity of trauma, neurological status (GCS, pupils) at admission and patency of the basal cisterns on the first computed tomography (CT) scan. Favourable outcome was achieved in 74 % of all patients; the rates were significantly different between GCS groups (93, 83, 37 and 10 %, respectively). Within each of the GCS groups, significant differences regarding age and trauma severity were found between patients with favourable versus unfavourable outcomes; neurological status at admission and CT findings were not relevant.
The GCS score at ICU discharge is a good predictor of 1-year outcome. Patients with a GCS score <10 at ICU discharge have a poor chance of favourable outcome.
分析重症监护病房（ICU）出院时格拉斯哥昏迷量表（GCS）评分与重度创伤性脑损伤（TBI）患者1年预后之间的关联。
对前瞻性收集的观察数据进行回顾性分析。
在2001年1月至2005年12月期间，13个欧洲中心纳入了1172例重度TBI患者。收集了有关事故、治疗和预后的数据。根据ICU出院时的GCS评分，将幸存者分为四组：GCS评分3 - 6分、7 - 9分、10 - 12分和13 - 15分。使用格拉斯哥预后量表（GOS），将1年预后分为“良好”（评分5分、4分）或“不良”（评分<4分）。比较了各组之间以及每组内良好与不良预后之间可能导致预后的因素。
在分析的538例患者中，308例（57%）在ICU出院时GCS评分为13 - 15分，101例（19%）评分为10 - 12分，46例（9%）评分为7 - 9分，83例（15%）评分为3 - 6分。与这些GCS评分显著相关的因素包括年龄、创伤严重程度、入院时的神经状态（GCS、瞳孔）以及首次计算机断层扫描（CT）上基底池的通畅情况。所有患者中有74%获得了良好预后；GCS组之间的比例有显著差异（分别为93%、83%、37%和10%）。在每个GCS组内，良好与不良预后患者之间在年龄和创伤严重程度方面存在显著差异；入院时的神经状态和CT检查结果无关。
ICU出院时的GCS评分是1年预后的良好预测指标。ICU出院时GCS评分<10分的患者获得良好预后的机会很小。
