Flynn-OʼBrien Katherine T, Fawcett Vanessa J, Nixon Zeynep A, Rivara Frederick P, Davidson Giana H, Chesnut Randall M, Ellenbogen Richard G, Vavilala Monica S, Bulger Eileen M, Maier Ronald V, Arbabi Saman
*Harborview Injury Prevention and Research Center, Seattle, Washington; ‡Departments of Surgery, ‖Pediatrics, and #Neurosurgery, Harborview Medical Center and University of Washington, Seattle, Washington; §Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia; ¶Washington State Department of Health, Olympia, Washington.
Neurosurgery. 2015 Apr;76(4):451-60. doi: 10.1227/NEU.0000000000000693.
Surgical intervention for severe traumatic brain injury (TBI) caused by extra-axial hemorrhage has declined in recent decades. The effect of this change on patient outcomes is unknown.
To determine the change over time in surgical intervention in this population and to assess changes in patient outcomes.
In this retrospective cohort study, the Washington State Trauma Registry was queried from 1995 to 2012 for patients with extra-axial hemorrhage and head Abbreviated Injury Scale score of 3 to 5. Data were linked to the state-wide death registry to analyze long-term mortality. The primary outcome was inpatient mortality. Secondary outcomes included 6- and 12-month mortality and modified Functional Independence Measure at discharge. Multivariable analyses were completed for all outcomes.
A total of 22974 patients met inclusion criteria. Over the study period, surgical intervention for severe TBI declined from 36% to 7%. There was a decline in case fatality from 22% to 12%. In 2012, the relative risk of inpatient mortality was 23% lower compared with 1995 (adjusted mortality risk ratio, 0.77; 95% confidence interval, 0.63-0.94). Changes in 6- and 12-month adjusted mortality and modified Functional Independence Measure were not statistically significant.
The decline in surgical intervention for severe TBI caused by extra-axial hemorrhage in Washington State was ubiquitous across regional, demographic, and injury characteristic strata. There was concurrently a reduction in inpatient mortality in this population. Functional status and long-term mortality, however, have remained the same. Future studies are needed to better identify modifiable risk factors for improvement in functional status and long-term mortality in this population.
近几十年来，因轴外出血导致的严重创伤性脑损伤（TBI）的手术干预有所减少。这种变化对患者预后的影响尚不清楚。
确定该人群手术干预随时间的变化，并评估患者预后的变化。
在这项回顾性队列研究中，查询了1995年至2012年华盛顿州创伤登记处中轴外出血且头部简明损伤量表评分为3至5分的患者。数据与全州死亡登记处相关联以分析长期死亡率。主要结局是住院死亡率。次要结局包括6个月和12个月死亡率以及出院时改良的功能独立性测量。对所有结局进行多变量分析。
共有22974名患者符合纳入标准。在研究期间，严重TBI的手术干预从36%降至7%。病死率从22%降至12%。2012年，与1995年相比，住院死亡率的相对风险降低了23%（调整后的死亡风险比，0.77；95%置信区间，0.63 - 0.94）。6个月和12个月调整后死亡率以及改良功能独立性测量的变化无统计学意义。
华盛顿州因轴外出血导致的严重TBI手术干预的下降在地区、人口统计学和损伤特征层面普遍存在。该人群的住院死亡率同时有所降低。然而，功能状态和长期死亡率保持不变。需要进一步研究以更好地确定可改变的风险因素，以改善该人群的功能状态和长期死亡率。
