Lund Stine B, Gjeilo Kari H, Moen Kent G, Schirmer-Mikalsen Kari, Skandsen Toril, Vik Anne
Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Neuroscience, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 3250 Sluppen, N-7006, Trondheim, Norway.
Scand J Trauma Resusc Emerg Med. 2016 May 23;24:77. doi: 10.1186/s13049-016-0269-5.
Patients with moderate traumatic brain injury (TBI) are a heterogeneous group with great variability in clinical course. Guidelines for monitoring and level of care in the acute phase are lacking. The main aim of this observational study was to describe injury severity and the acute phase course during the first three days post-injury in a cohort of patients with moderate TBI. Deviations from defined parameters in selected physiological variables were also studied, based on guidelines for severe TBI during the same period.
During a 5-year period (2004-2009), 119 patients ≥16 years (median age 47 years, range 16-92) with moderate TBI according to the Head Injury Severity Scale were admitted to a Norwegian level 1 trauma centre. Injury-related and acute phase data were collected prospectively. Deviations in six physiological variables were collected retrospectively.
Eighty-six percent of the patients had intracranial pathology on CT scan and 61 % had extracranial injuries. Eighty-four percent of all patients were admitted to intensive care units (ICUs) the first day, and 51 % stayed in ICUs ≥3 days. Patients staying in ICUs ≥3 days had lower median Glasgow Coma Scale score; 12 (range 9-15) versus 13 (range 9-15, P = 0.003) and more often extracranial injuries (77 % versus 42 %, P = 0.001) than patients staying in ICU 0-2 days. Most patients staying in ICUs ≥3 days had at least one episode of hypotension (53 %), hypoxia (57 %), hyperthermia (59 %), anaemia (56 %) and hyperglycaemia (65 %), and the proportion of anaemia related to number of measurements was high (33 %).
Most of the moderate TBI patients stayed in an ICU the first day, and half of them stayed in ICUs ≥3 days due to not only intracranial, but also extracranial injuries. Deviations in physiological variables were often seen in this latter group of patients. Lack of guidelines for patients with moderate TBI may leave these deviations uncorrected. We propose that in future research of moderate TBI, patients might be differentiated with regard to their need for monitoring and level of care the first few days post-injury. This could contribute to improvement of acute phase management.
中度创伤性脑损伤（TBI）患者是一个异质性群体，临床病程差异很大。目前缺乏急性期监测和护理水平的指南。这项观察性研究的主要目的是描述一组中度TBI患者受伤后前三天的损伤严重程度和急性期病程。还根据同期重度TBI的指南，研究了选定生理变量与定义参数的偏差。
在5年期间（2004 - 2009年），119名年龄≥16岁（中位年龄47岁，范围16 - 92岁）、根据头部损伤严重程度量表诊断为中度TBI的患者被收治到挪威一级创伤中心。前瞻性收集与损伤相关和急性期的数据。回顾性收集六个生理变量的偏差。
86%的患者CT扫描显示有颅内病变，61%有颅外损伤。所有患者中84%在第一天被收入重症监护病房（ICU），51%在ICU住院≥3天。在ICU住院≥3天的患者格拉斯哥昏迷量表评分中位数较低；分别为12分（范围9 - 15分）和13分（范围9 - 15分，P = 0.003），且与在ICU住院0 - 2天的患者相比，颅外损伤更常见（77%对42%，P = 0.001）。大多数在ICU住院≥3天的患者至少有一次低血压（53%）、缺氧（57%）、体温过高（59%）、贫血（56%）和高血糖（65%）发作，且与测量次数相关的贫血比例较高（33%）。
大多数中度TBI患者在第一天入住ICU，其中一半因不仅有颅内损伤，还有颅外损伤而在ICU住院≥3天。后一组患者中经常出现生理变量的偏差。缺乏中度TBI患者的指南可能会使这些偏差得不到纠正。我们建议，在未来中度TBI的研究中，可根据患者受伤后最初几天对监测和护理水平的需求进行区分。这可能有助于改善急性期管理。
