Ho Chung-Han, Liang Fu-Wen, Wang Jhi-Joung, Chio Chung-Ching, Kuo Jinn-Rung
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
PLoS One. 2018 Jan 11;13(1):e0190683. doi: 10.1371/journal.pone.0190683. eCollection 2018.
Traumatic brain injury (TBI) is an important health issue with high mortality. Various complications of physiological and cognitive impairment may result in disability or death after TBI. Grouping of these complications could be treated as integrated post-TBI syndromes. To improve risk estimation, grouping TBI complications should be investigated, to better predict TBI mortality. This study aimed to estimate mortality risk based on grouping of complications among TBI patients. Taiwan's National Health Insurance Research Database was used in this study. TBI was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes: 801-804 and 850-854. The association rule data mining method was used to analyze coexisting complications after TBI. The mortality risk of post-TBI complication sets with the potential risk factors was estimated using Cox regression. A total 139,254 TBI patients were enrolled in this study. Intracerebral hemorrhage was the most common complication among TBI patients. After frequent item set mining, the most common post-TBI grouping of complications comprised pneumonia caused by acute respiratory failure (ARF) and urinary tract infection, with mortality risk 1.55 (95% C.I.: 1.51-1.60), compared with those without the selected combinations. TBI patients with the combined combinations have high mortality risk, especially those aged <20 years with septicemia, pneumonia, and ARF (HR: 4.95, 95% C.I.: 3.55-6.88). We used post-TBI complication sets to estimate mortality risk among TBI patients. According to the combinations determined by mining, especially the combination of septicemia with pneumonia and ARF, TBI patients have a 1.73-fold increased mortality risk, after controlling for potential demographic and clinical confounders. TBI patients aged<20 years with each combination of complications also have increased mortality risk. These results could provide physicians and caregivers with important information to increase their awareness about sequences of clinical syndromes among TBI patients, to prevent possible deaths among these patients.
创伤性脑损伤（TBI）是一个重要的健康问题，死亡率很高。TBI后生理和认知功能障碍的各种并发症可能导致残疾或死亡。这些并发症的分组可视为TBI后综合综合征。为了改善风险评估，应研究TBI并发症的分组，以更好地预测TBI死亡率。本研究旨在基于TBI患者并发症的分组来估计死亡风险。本研究使用了台湾地区国民健康保险研究数据库。TBI根据《国际疾病分类，第九版，临床修订本》代码801 - 804和850 - 854进行定义。采用关联规则数据挖掘方法分析TBI后的共存并发症。使用Cox回归估计具有潜在风险因素的TBI后并发症组的死亡风险。本研究共纳入139254例TBI患者。脑出血是TBI患者中最常见的并发症。经过频繁项集挖掘，TBI后最常见的并发症分组包括急性呼吸衰竭（ARF）引起的肺炎和尿路感染，与未选择这些组合的患者相比，死亡风险为1.55（95%置信区间：1.51 - 1.60）。具有这些组合的TBI患者有较高的死亡风险，尤其是年龄<20岁且患有败血症、肺炎和ARF的患者（风险比：4.95，95%置信区间：3.55 - 6.88）。我们使用TBI后并发症组来估计TBI患者的死亡风险。根据挖掘确定的组合，特别是败血症与肺炎和ARF的组合，在控制潜在的人口统计学和临床混杂因素后，TBI患者的死亡风险增加了1.73倍。年龄<20岁且有每种并发症组合的TBI患者死亡风险也增加。这些结果可为医生和护理人员提供重要信息，以提高他们对TBI患者临床综合征序列的认识，预防这些患者可能的死亡。
