Strnad Matej, Borovnik Lesjak Vesna, Vujanović Vitka, Križmarić Miljenko
Center for Emergency Medicine, Community Health Center Maribor, Prehospital Unit, Ulica talcev 9, 2000, Maribor, Slovenia.
Medical Faculty, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia.
Wien Klin Wochenschr. 2017 Feb;129(3-4):110-114. doi: 10.1007/s00508-016-0974-0. Epub 2016 Mar 11.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Many prognostic models predicting mortality in patients with TBI were developed, which also include patients with mild or moderate TBI and patients who suffered major extracranial injuries.
From a prospective database, we conducted a retrospective medical chart review covering the period between January 2000 and December 2012 of patients with isolated severe TBI (Abbreviated Injury Score for head, AIS ≥ 3) without extracranial injuries, who were intubated in the field using the rapid sequence intubation method and were of age 16 or more. Prehospital vital signs, Injury Severity Score (ISS) and laboratory tests were compared in two study groups: survivors (n = 25) and non-survivors (n = 27). Selected variables identified during univariate analysis (p < 0.1) were then subjected to multivariate analysis logistic regression model.
Univariate analysis showed that in-hospital mortality was statistically significantly associated with male sex (p = 0.040), ISS (p = 0.005) and mydriasis (p = 0.012). For predicting mortality, area under the curve (AUC) was calculated: for ISS 0.76 (95 % confidence interval, CI; 0.63-0.90; p < 0.001) and for initial Glasgow Coma Scale (GCS) 0.64 (95 % CI, 0.49-0.80, p = 0.079). In the multivariate analysis, ISS (odds ratio, OR; 1.19, 95 % CI, 1.06-1.35; p = 0.004) and mydriasis (OR, 5.73; 95 % CI, 1.06-30.88; p = 0.042) were identified as independent risk factors for in-hospital mortality. The AUC for the regression model was 0.83 (95 % CI, 0.71-0.94; p < 0.001).
In prehospital intubated patients with isolated severe TBI only ISS and mydriasis were found to be independent predictors of in-hospital mortality.
创伤性脑损伤（TBI）是全球范围内死亡和残疾的主要原因。许多预测TBI患者死亡率的预后模型已经建立，其中也包括轻度或中度TBI患者以及遭受严重颅外损伤的患者。
我们从一个前瞻性数据库中进行了一项回顾性病历审查，涵盖2000年1月至2012年12月期间孤立性重度TBI（头部简略损伤评分，AIS≥3）且无颅外损伤的患者，这些患者在现场采用快速顺序插管法进行了插管，年龄在16岁及以上。在两个研究组中比较了院前生命体征、损伤严重程度评分（ISS）和实验室检查结果：幸存者（n = 25）和非幸存者（n = 27）。然后将单因素分析（p < 0.1）中确定的选定变量纳入多因素分析逻辑回归模型。
单因素分析显示，院内死亡率与男性（p = 0.040）、ISS（p = 0.005）和瞳孔散大（p = 0.012）在统计学上显著相关。为预测死亡率，计算了曲线下面积（AUC）：ISS的AUC为0.76（95%置信区间，CI；0.63 - 0.90；p < 0.001），初始格拉斯哥昏迷量表（GCS）的AUC为0.64（95%CI，0.49 - 0.80，p = 0.079）。在多因素分析中，ISS（比值比，OR；1.19，95%CI，1.06 - 1.35；p = 0.004）和瞳孔散大（OR，5.73；95%CI，1.06 - 30.88；p = 0.042）被确定为院内死亡率的独立危险因素。回归模型的AUC为0.83（95%CI，0.71 - 0.94；p < 0.001）。
在院前插管的孤立性重度TBI患者中，仅发现ISS和瞳孔散大是院内死亡率的独立预测因素。
