Talari Hamid Reza, Hamidian Yaser, Moussavi Nooshin, Fakharian Esmail, Abedzadeh-Kalahroudi Masoumeh, Akbari Hossein, Taher Elaheh Baban
Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
World Neurosurg. 2019 May;125:e139-e145. doi: 10.1016/j.wneu.2018.12.221. Epub 2019 Jan 21.
Prediction of traumatic brain injury (TBI) among children is of great importance for accurate clinical decision making.
This study aimed to determine the prognostic value of the Rotterdam scoring system in predicting early outcome among children with TBI.
This study was conducted in 2017 on 506 children with brain injury in Kashan, Iran. A checklist was used to collect demographic and clinical characteristics of patients such as age, sex, mechanism of trauma, Glasgow Coma Scale (GCS) score, need for surgery, and brain injury outcome. Moreover, each participant's computed tomography scan was evaluated and scored using the Rotterdam system. Sensitivity, specificity, positive and negative predictive values, and the best cut-off score were calculated for the Rotterdam system. The relationships of the Rotterdam score with participants' characteristics were examined using the χ test, whereas the predictors of brain injury outcome were identified using the logistic regression analysis.
Pediatric death rate was 4.3%. Most deaths were among children who were male, aged <4, had developed brain injury owing to traffic accidents, had a GCS score of 3-8, suffered from compressed skull fracture and frontal lobe injury, had cerebral edema, and had a Rotterdam score of 5. The sensitivity and specificity of a Rotterdam score 3 were 86.4% and 97.9%, respectively. The logistic regression analysis indicated that only GCS and Rotterdam scores were significant predictors of brain injury outcome.
At a cut-off score of 3, the Rotterdam system can be used to predict TBI outcome among children with acceptable sensitivity and specificity.
儿童创伤性脑损伤（TBI）的预测对于准确的临床决策至关重要。
本研究旨在确定鹿特丹评分系统在预测儿童TBI早期预后方面的价值。
2017年在伊朗卡尚对506例脑损伤儿童进行了这项研究。使用一份清单收集患者的人口统计学和临床特征，如年龄、性别、创伤机制、格拉斯哥昏迷量表（GCS）评分、手术需求和脑损伤结局。此外，使用鹿特丹系统对每位参与者的计算机断层扫描进行评估和评分。计算鹿特丹系统的敏感性、特异性、阳性和阴性预测值以及最佳截断分数。使用χ检验检查鹿特丹评分与参与者特征之间的关系，而使用逻辑回归分析确定脑损伤结局 的预测因素。
儿童死亡率为4.3%。大多数死亡发生在男性、年龄<4岁、因交通事故导致脑损伤、GCS评分为3-8分、患有颅骨压缩性骨折和额叶损伤、有脑水肿且鹿特丹评分为5分的儿童中。鹿特丹评分为3时的敏感性和特异性分别为86.4%和97.9%。逻辑回归分析表明，只有GCS和鹿特丹评分是脑损伤结局的显著预测因素。
在截断分数为3时，鹿特丹系统可用于以可接受的敏感性和特异性预测儿童TBI的结局。
