创伤性脑损伤患者院前神经恶化是结局的独立预测因素：来自国家创伤数据库的分析。

Prehospital neurologic deterioration is independent predictor of outcome in traumatic brain injury: analysis from National Trauma Data Bank.

机构信息

Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 55455, USA.

出版信息

Am J Emerg Med. 2013 Aug;31(8):1215-9. doi: 10.1016/j.ajem.2013.05.026. Epub 2013 Jul 1.

DOI:10.1016/j.ajem.2013.05.026

PMID:23809095

Abstract

BACKGROUND

The prevalence and impact of prehospital neurologic deterioration (PhND) in patients with traumatic brain injury (TBI) have not been investigated. We aimed to determine the prevalence of PhND during emergency medical service (EMS) transportation among patients with TBI and its impact on patient's outcome.

METHODS

We used the National Trauma Data Bank, using data files from 2009 to 2010 to identify patients with TBI through International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The initial Glasgow Coma Scale (GCS) score ascertained at the scene by EMS was compared with the subsequent GCS score evaluation in the emergency department (ED) to identify neurologic deterioration (defined as a decrease in GCS of ≥2 points). Patients' demographics, initial injury severity score (ISS), admission GCS score, and hospital outcome were compared between patients with PhND and patients without neurologic deterioration.

RESULTS

A total of 257 127 patients with TBI were identified. Among patients with TBI, 22 254 patients had PhND, which comprised 9% of all patients with TBI. The mean of GCS score decrease during EMS transport was 5 points (±3). Patients without PhND tended to have higher GCS recorded by EMS (median, 15 vs 12; P < .0001). Patients with TBI who had PhND had significantly higher hospital length of stay and intensive care unit days after adjusting for baseline characteristics and EMS GCS score, EMS transport time, type of injury, presence of intracranial hemorrhages, and ED ISS (P < .0001). These patients had higher rate of in-hospital mortality after adjusting for the same variables (odds ratio, 2.30; 95% confidence interval, 2.18-2.41).

CONCLUSION

Prehospital neurologic deterioration occurs in 9% of patients with TBI. It is more prevalent in men and associated with lower EMS GCS level and higher ED ISS. Prehospital neurologic deterioration is an independent predictor of worse hospital outcome and higher resource use in patients with TBI.

摘要

背景

在创伤性脑损伤（TBI）患者中，院前神经功能恶化（PhND）的发生率和影响尚未得到研究。我们旨在确定 TBI 患者在急诊医疗服务（EMS）转运期间 PhND 的发生率及其对患者预后的影响。

方法

我们使用国家创伤数据库，使用 2009 年至 2010 年的数据文件，通过国际疾病分类，第九修订版，临床修正诊断代码来确定 TBI 患者。通过 EMS 在现场确定的初始格拉斯哥昏迷评分（GCS）与急诊科的后续 GCS 评分评估进行比较，以确定神经功能恶化（定义为 GCS 下降≥2 分）。比较 PhND 患者和无神经功能恶化患者的患者人口统计学资料、初始损伤严重程度评分（ISS）、入院 GCS 评分和住院结局。

结果

共确定了 257127 例 TBI 患者。在 TBI 患者中，有 22254 例发生 PhND，占所有 TBI 患者的 9%。EMS 转运过程中 GCS 评分下降的平均值为 5 分（±3）。无 PhND 的患者在 EMS 记录的 GCS 评分较高（中位数，15 对 12；P<0.0001）。调整基线特征和 EMS GCS 评分、EMS 转运时间、损伤类型、颅内出血存在和 ED ISS 后，PhND 的 TBI 患者住院时间和 ICU 天数显著增加（均 P<0.0001）。在调整相同变量后，这些患者的住院死亡率也较高（比值比，2.30；95%置信区间，2.18-2.41）。