Stenberg Maud, Koskinen Lars-Owe D, Jonasson Per, Levi Richard, Stålnacke Britt-Marie
a Department of Community Medicine and Rehabilitation , Rehabilitation Medicine.
b Department of Pharmacology and Clinical Neuroscience , Neurosurgery.
Brain Inj. 2017;31(3):351-358. doi: 10.1080/02699052.2016.1261303. Epub 2017 Feb 16.
To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).
Initial CT (CT) and CT 24 hours post-trauma (CT) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.
Thirty-seven patients were included. Marshall CT and CT were significantly correlated with RLAS-R at three months. Rotterdam CT was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.
Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.
研究：（i）急性计算机断层扫描（CT）特征及临床结果；（ii）临床病程；（iii）重度颅脑损伤（sTBI）患者的重度颅脑损伤后皮质类固醇随机化急性计算方案（CRASH）模型及临床结果。
根据马歇尔和鹿特丹分类法评估初始CT及创伤后24小时的CT。在创伤后三个月和一年时评估兰乔洛斯阿米戈斯认知量表修订版（RLAS-R）和格拉斯哥扩展预后量表（GOSE）。评估CRASH模型的预后价值。
纳入37例患者。三个月时，马歇尔CT与RLAS-R显著相关。三个月时，鹿特丹CT与GOSE显著相关。从三个月到一年，RLAS-R和GOSE显著改善。根据一年时的GOSE，CRASH对81%预后不良的患者和85%预后良好的患者在六个月时预测为不良结局。
CT和CRASH在伤后一年均未产生对结局有临床实用价值的预测。该研究令人鼓舞地显示，在这群sTBI患者中有许多显著恢复的实例。缺乏可靠的预后指标与良好结局并存，支持了在sTBI病例中将强化急性处理和康复作为默认方案的理由。
