创伤性脑损伤后损伤当日计算机断层扫描的容积分析与康复结果相关。
Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.
作者信息
Majercik Sarah, Bledsoe Joseph, Ryser David, Hopkins Ramona O, Fair Joseph E, Brock Frost R, MacDonald Joel, Barrett Ryan, Horn Susan, Pisani David, Bigler Erin D, Gardner Scott, Stevens Mark, Larson Michael J
机构信息
From the Division of Trauma Services and Surgical Critical Care (S.M., M.S.), Intermountain Medical Center, Murray, UT; Department of Emergency Medicine (J.B.), Intermountain Medical Center, Murray, UT; Department of Rehabilitation Medicine (D.R.), Intermountain Medical Center, Murray, UT; Department of Medicine, Pulmonary and Critical Care Division (R.H.), Intermountain Medical Center, Murray, Utah; Center for Humanizing Critical Care, Intermountain Medicine, Murray, Utah and Department of Psychology and Neuroscience Center (R.H.), Brigham Young University, Provo, UT; Department of Psychology (J.F.), Brigham Young University, Provo, UT; Department of Psychiatry (R.B.F), University of New Mexico College of Medicine, Albuquerque, NM; Department of Psychology (R.B.F), Brigham Young University, Provo, UT; Department of Neurosurgery (J.M.), University of Utah, Salt Lake City, UT; Intermountain Medical Center, Murray, UT; Institute for Clinical Outcomes Research (R.B., S.H.), Salt Lake City, UT; Department of Radiology (D.P.), Intermountain Medical Center; Department of Psychology and Neuroscience Center (E.B.), Brigham Young University, Provo, UT; Division of Trauma Services (S.G), Intermountain Medical Center, Murray, UT; and Department of Psychology and Neuroscience Center (M.L.), Brigham Young University, Provo, UT.
出版信息
J Trauma Acute Care Surg. 2017 Jan;82(1):80-92. doi: 10.1097/TA.0000000000001263.
BACKGROUND
Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center.
METHODS
Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor Functional Independence Measure (FIM) scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. The DOI quantitative injury lesion volumes and degree of midline shift were obtained from DOI brain computed tomography scans. A multiple stepwise regression model including 13 independent variables was created. This model was used to predict postrehabilitation outcomes, including FIM scores and ability to return to home. A p value less than 0.05 was considered significant.
RESULTS
Ninety-six patients were enrolled in the study. Mean age was 43 ± 21 years, admission Glasgow Coma Score was 8.4 ± 4.8, Injury Severity Score was 24.7 ± 9.9, and head Abbreviated Injury Scale score was 3.73 ± 0.97. Acute hospital LOS was 12.3 ± 8.9 days, and rehabilitation LOS was 15.9 ± 9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p = 0.004) and discharge (p = 0.004) and inversely associated with ability to be discharged to home after rehabilitation (p = 0.006).
CONCLUSION
In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller-injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.
LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level V.
背景
创伤性脑损伤（TBI）患者受伤当日（DOI）的脑损伤体积在急性情况下很少用于预测长期预后。本研究的目的是在一级创伤中心调查TBI患者急性脑损伤体积与康复结局之间的关系。
方法
2009年2月至2011年7月在急性创伤护理服务后入住我们康复科的TBI患者符合本研究条件。获取人口统计学数据和结局变量，包括认知和运动功能独立性测量（FIM）评分、在康复科的住院时间（LOS）以及回家的能力。DOI定量损伤体积和中线移位程度从DOI脑部计算机断层扫描中获取。创建了一个包含13个自变量的多元逐步回归模型。该模型用于预测康复后结局，包括FIM评分和回家的能力。p值小于0.05被认为具有统计学意义。
结果
96名患者纳入研究。平均年龄为43±21岁，入院时格拉斯哥昏迷评分为8.4±4.8，损伤严重程度评分为24.7±9.9，头部简明损伤量表评分为3.73±0.97。急性住院LOS为12.3±8.9天，康复LOS为15.9±9.3天。受伤当日TBI损伤体积与康复入院时（p = 0.004）和出院时（p = 0.004）的认知FIM评分呈负相关，与康复后回家的能力呈负相关（p = 0.006）。
结论
在一组中度至重度TBI患者中，急性护理住院后需要入住康复科，受伤当日脑损伤体积与康复入院和出院时较差的认知FIM评分相关。较小的损伤体积与最终回家相关。急性损伤期的体积神经影像学检查可能会改善外科医生对TBI患者最终结局的预测。
证据水平
预后/流行病学研究，V级。
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