Yue John K, Winkler Ethan A, Sharma Sourabh, Vassar Mary J, Ratcliff Jonathan J, Korley Frederick K, Seabury Seth A, Ferguson Adam R, Lingsma Hester F, Deng Hansen, Meeuws Sacha, Adeoye Opeolu M, Rick Jonathan W, Robinson Caitlin K, Duarte Siena M, Yuh Esther L, Mukherjee Pratik, Dikmen Sureyya S, McAllister Thomas W, Diaz-Arrastia Ramon, Valadka Alex B, Gordon Wayne A, Okonkwo David O, Manley Geoffrey T
a Department of Neurological Surgery , University of California, San Francisco , San Francisco , CA , USA.
b Brain and Spinal Injury Center , San Francisco General Hospital , San Francisco , CA , USA.
Brain Inj. 2017;31(13-14):1820-1829. doi: 10.1080/02699052.2017.1351000.
To investigate the clinical management and medical follow-up of patients with mild traumatic brain injury (mTBI) presenting to emergency departments (EDs).
Overall, 168 adult patients with mTBI from the prospective, multicentre Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study with Glasgow Coma Scale (GCS) 13-15, no polytrauma and alive at six months were included. Predictors for hospital admission, three-month follow-up referral and six-month functional disability (Glasgow Outcome Scale-Extended (GOSE) ≤ 6) were analysed using multivariable regression.
Overall, 48% were admitted to hospital, 22% received three-month referral and 27% reported six-month functional disability. Intracranial pathology on ED head computed tomography (multivariable odds ratio (OR) = 81.08, 95% confidence interval (CI) [10.28-639.36]) and amnesia (>30-minutes: OR = 5.27 [1.75-15.87]; unknown duration: OR = 4.43 [1.26-15.62]) predicted hospital admission. Older age (per-year OR = 1.03 [1.01-1.05]) predicted three-month referral, while part-time/unemployment predicted lack of referral (OR = 0.17 [0.06-0.50]). GCS < 15 (OR = 2.46 [1.05-5.78]) and prior history of seizures (OR = 3.62 [1.21-10.89]) predicted six-month functional disability, while increased education (per-year OR = 0.86 [0.76-0.97]) was protective.
Clinical factors modulate triage to admission, while demographic/socioeconomic elements modulate follow-up care acquisition; six-month functional disability associates with both clinical and demographic/socioeconomic variables. Improving triage to acute and outpatient care requires further investigation to optimize resource allocation and outcome after mTBI. ClinicalTrials.gov registration: NCT01565551.
探讨急诊科收治的轻度创伤性脑损伤（mTBI）患者的临床管理和医学随访情况。
总共纳入了168例来自前瞻性多中心创伤性脑损伤转化研究与临床知识（TRACK-TBI）试点研究的成年mTBI患者，这些患者格拉斯哥昏迷量表（GCS）评分为13 - 15分，无多发伤且在6个月时存活。采用多变量回归分析住院、3个月随访转诊及6个月功能残疾（格拉斯哥扩展预后量表（GOSE）≤6）的预测因素。
总体而言，48%的患者入院，22%的患者接受了3个月的转诊，27%的患者报告有6个月的功能残疾。急诊头颅计算机断层扫描显示颅内病变（多变量比值比（OR）= 81.08，95%置信区间（CI）[10.28 - 639.36]）和失忆（>30分钟：OR = 5.27 [1.75 - 15.87]；持续时间未知：OR = 4.43 [1.26 - 15.62]）可预测入院。年龄较大（每年OR = 1.03 [1.01 - 1.05]）可预测3个月的转诊，而兼职/失业则可预测未转诊（OR = 0.17 [0.06 - 0.50]）。GCS < 15（OR = 2.46 [1.05 - 5.78]）和既往癫痫病史（OR = 3.62 [1.21 - 10.89]）可预测6个月的功能残疾，而受教育程度提高（每年OR = 0.86 [0.76 - 0.97]）具有保护作用。
临床因素调节入院分诊，而人口统计学/社会经济因素调节后续护理的获取；6个月的功能残疾与临床及人口统计学/社会经济变量均相关。改善急性和门诊护理的分诊需要进一步研究，以优化mTBI后的资源分配和预后。ClinicalTrials.gov注册号：NCT01565551。
