Mejaddam Ali Y, Elmer Jonathan, Sideris Antonios C, Chang Yuchiao, Petrovick Laurie, Alam Hasan B, Fagenholz Peter J
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Emerg Med. 2013 Sep;45(3):384-91. doi: 10.1016/j.jemermed.2013.04.015. Epub 2013 Jun 12.
Data suggest that prolonged Emergency Department length of stay (EDLOS) has a detrimental effect on outcomes in some critically ill patients. However, the relationship between EDLOS and outcomes in traumatic brain injury (TBI) has not been examined.
Our objective was to determine the effect of EDLOS on neurologic outcomes in TBI patients.
We performed a retrospective analysis of a prospectively identified cohort of patients with moderate (Glasgow Coma Scale [GCS] score 9-13) and severe (GCS ≤ 8) TBI who presented to a Level 1 trauma center (2006-2010). Inclusion criteria were transfer to the intensive care unit (ICU) or operating room (OR) from the ED. Primary outcome was Glasgow Outcome Scale (GOS) score, a measure of neurologic function, at discharge. We used a proportional odds model to control for significant predictors of GOS in univariate analysis.
Two hundred and twenty-four patients were included in the analysis, 77 (34%) of which were transferred to the OR. Median EDLOS was 3.3 h and 81.2% of patients had a GOS score ≤3 (e.g., severe disability, vegetative, or deceased). In multivariable analyses, EDLOS was not associated with GOS score in either ICU bound (p = 0.57) or OR bound (p = 0.11) patients. Younger age, pupil reactivity, and absence of intubation were independent predictors of good outcomes in the ICU group. In OR patients, predictors of higher GOS score included presence of an epidural hemorrhage, absence of midline shift, and pupil reactivity.
Our study demonstrates that EDLOS was not associated with poor outcomes in patients with moderate to severe TBI who required intensive care or early operative intervention in an academic Level 1 trauma center.
数据表明，急诊科住院时间延长（EDLOS）对一些危重症患者的预后有不利影响。然而，EDLOS与创伤性脑损伤（TBI）预后之间的关系尚未得到研究。
我们的目的是确定EDLOS对TBI患者神经功能预后的影响。
我们对前瞻性确定的一组中度（格拉斯哥昏迷量表[GCS]评分9 - 13）和重度（GCS≤8）TBI患者进行了回顾性分析，这些患者均送至一级创伤中心（2006 - 2010年）。纳入标准为从急诊科转入重症监护病房（ICU）或手术室（OR）。主要结局是出院时格拉斯哥预后量表（GOS）评分，这是一种神经功能的衡量指标。我们在单变量分析中使用比例优势模型来控制GOS的显著预测因素。
224例患者纳入分析，其中77例（34%）转入手术室。EDLOS中位数为3.3小时，81.2%的患者GOS评分≤3（例如，严重残疾、植物人状态或死亡）。在多变量分析中，无论是转入ICU的患者（p = 0.57）还是转入手术室的患者（p = 0.11），EDLOS均与GOS评分无关。年龄较小、瞳孔反应性和未插管是ICU组良好预后的独立预测因素。在手术室患者中，GOS评分较高的预测因素包括硬膜外出血、无中线移位和瞳孔反应性。
我们的研究表明，在一级学术创伤中心，对于需要重症监护或早期手术干预的中度至重度TBI患者，EDLOS与不良预后无关。
