Savitsky B, Givon A, Rozenfeld M, Radomislensky I, Peleg K
a Israel National Center for Trauma and Emergency Medicine Research , Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Ramat Gan , Israel.
b Faculty of Medicine , Tel-Aviv University, School of Public Health , Tel-Aviv , Israel.
Brain Inj. 2016;30(10):1194-200. doi: 10.1080/02699052.2016.1187290. Epub 2016 Jul 28.
TBI may be defined by different methods. Some may be most useful for immediate clinical purposes, however less optimal for epidemiologic research. Other methods, such as the Abbreviated Injury Score (AIS), may prove more beneficial for this task, if the cut-off-points for their categories are defined correctly.
To reveal the optimal cut-off-points for AIS in definition of severity of TBI in order to ensure uniformity between future studies of TBI.
Mortality of patients with TBI AIS 3, 4 was 1.9% and 2.9% respectively, comparing with 31.1% among TBI AIS 5+. Predictive discrimination ability of the model with cut-off-points of 5+ for TBI AIS (in comparison with other cut-off-points) was better. Patients with missing Glasgow Coma Scale (GCS) in the ED had an in-hospital mortality rate of 11.5%. In this group, 25% had critical TBI according to AIS. Normal GCS didn't indicate an absence of head injury, as, among patients with GCS 15 in the ED, 26% had serious/critical TBI injury. Moreover, 7% of patients with multiple injury and GCS 3-8 had another reason than head injury for unconsciousness.
This study recommends the adoption of an AIS cut-off ≥ 5 as a valid definition of severe TBI in epidemiological studies, while AIS 3-4 may be defined as 'moderate' TBI and AIS 1-2 as 'mild'.
创伤性脑损伤（TBI）可以通过不同方法来定义。有些方法可能对即时临床目的最为有用，但对流行病学研究而言并非最佳。其他方法，如简明损伤评分（AIS），如果其类别切点定义正确，可能对这项任务更有益。
揭示AIS在定义TBI严重程度时的最佳切点，以确保未来TBI研究之间的一致性。
TBI AIS 3级、4级患者的死亡率分别为1.9%和2.9%，而TBI AIS 5级及以上患者的死亡率为31.1%。TBI AIS切点为5级及以上的模型（与其他切点相比）预测辨别能力更好。急诊科格拉斯哥昏迷量表（GCS）缺失的患者院内死亡率为11.5%。在该组中，根据AIS，25%的患者患有重度TBI。正常GCS并不表明没有头部损伤，因为在急诊科GCS为15分的患者中，26%患有严重/重度TBI损伤。此外，7%的多发伤且GCS为3 - 8分的患者昏迷的原因不是头部损伤。
本研究建议采用AIS切点≥5作为流行病学研究中重度TBI的有效定义，而AIS 3 - 4级可定义为“中度”TBI，AIS 1 - 2级为“轻度”TBI。
