我们应该恐惧多久？创伤性脑损伤患者静脉血栓栓塞的长期风险。
How long should we fear? Long-term risk of venous thromboembolism in patients with traumatic brain injury.
作者信息
Olufajo Olubode A, Yorkgitis Brian K, Cooper Zara, Rios-Diaz Arturo, Metcalfe David, Havens Joaquim M, Kelly Edward, Haider Adil H, Gates Jonathan D, Salim Ali
机构信息
From the Division of Trauma, Burn and Surgical Critical Care, Department of Surgery (O.A.O., B.K.Y., Z.C., J.M.H., E.D., A.H.H., J.D.G., A.S.), Brigham and Women's Hospital, Boston, MA; and Center for Surgery and Public Health (O.A.O., Z.C., A.R.-D., D.M., J.M.H., A.H.H., A.S.), Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA.
出版信息
J Trauma Acute Care Surg. 2016 Jul;81(1):71-8. doi: 10.1097/TA.0000000000001046.
BACKGROUND
Although patients with traumatic brain injury (TBI) are known to be at high risk for venous thromboembolism (VTE), it is not clear how long this risk persists after injury. We aimed to determine the risk of VTE in patients with TBI during one year after injury and to identify associated factors.
METHODS
Patients 18 years and older with International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses of isolated TBI (head Abbreviated Injury Scale [AIS] ≥3 and AIS <3 for all other body regions) were identified in the California State Inpatient Database (2007-2011). Patient and admission (injury severity score, length of stay, and discharge disposition) characteristics were assessed. Hospital factors (teaching status, trauma center verification, and bed size) were extracted from the American Hospital Association database. Patients who developed VTE during the index admission and at different time points after discharge were determined. Multivariate logistic regression models were used to assess the associated risk factors for VTE after discharge.
RESULTS
There were 38,984 patients with isolated TBI identified. The incidence of VTE was 1.31% during the index admission and the cumulative incidence of VTE involving hospitalization within one year of injury was 2.83%. The major risk factors for VTE one year after injury (not including the index admission) were discharge to extended care facilities versus home [adjusted odds ratio, 2.69 (95% confidence interval, 2.14-3.37)], age older than 64 years versus 18 to 44 years [2.62 (1.80-3.81)], having an operation during the index admission [1.65 (1.36-2.01)], and hospital length of stay of more than 7 days versus 3 days or less [1.64 (1.27-2.11)].
CONCLUSION
The risk of VTE persists long after discharge in a significant proportion of patients with TBI. Demographic and admission characteristics of patients play significant roles in the risk of VTE after discharge. These results highlight the need for sustained surveillance and preventive measures among patients with TBI at increased risk for long-term VTE.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
背景
尽管已知创伤性脑损伤（TBI）患者发生静脉血栓栓塞（VTE）的风险很高，但尚不清楚这种风险在受伤后会持续多久。我们旨在确定TBI患者受伤后一年内发生VTE的风险，并确定相关因素。
方法
在加利福尼亚州住院患者数据库（2007 - 2011年）中识别年龄在18岁及以上、国际疾病分类第九版临床修订本诊断为单纯性TBI（头部简明损伤量表[AIS]≥3，其他身体部位AIS<3）的患者。评估患者和入院（损伤严重程度评分、住院时间和出院处置）特征。医院因素（教学状况、创伤中心认证和床位规模）从美国医院协会数据库中提取。确定在首次入院期间及出院后不同时间点发生VTE的患者。使用多变量逻辑回归模型评估出院后VTE的相关危险因素。
结果
共识别出38984例单纯性TBI患者。首次入院期间VTE的发生率为1.31%，受伤后一年内涉及住院的VTE累积发生率为2.83%。受伤一年后（不包括首次入院）VTE的主要危险因素包括出院至长期护理机构而非回家[调整优势比，2.69（95%置信区间，2.14 - 3.37）]、年龄大于64岁与18至44岁相比[2.62（1.80 - 3.81）]、首次入院期间进行手术[1.65（1.36 - 2.01）]以及住院时间超过7天与3天或更短相比[1.64（1.27 - 2.11）]。
结论
相当一部分TBI患者出院后VTE风险持续很长时间。患者的人口统计学和入院特征在出院后VTE风险中起重要作用。这些结果凸显了对长期VTE风险增加的TBI患者进行持续监测和采取预防措施的必要性。
证据水平
流行病学研究，III级。
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