Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
Department of Neurosurgery & Radiology, Miami Miller School of Medicine, Miami University Hospital, Miami, Florida.
Neurosurgery. 2020 Jan 1;86(1):107-111. doi: 10.1093/neuros/nyy634.
Traumatic brain injury (TBI) carries a devastatingly high rate of morbidity and mortality.
To assess whether patients undergoing craniotomy/craniectomy for severe TBI fare better at level I than level II trauma centers in a mature trauma system.
The data were extracted from the Pennsylvania Trauma Outcome Study database. Inclusion criteria were patients > 18 yr with severe TBI (Glasgow Coma Scale [GCS] score less than 9) undergoing craniotomy or craniectomy in the state of Pennsylvania from January 1, 2002 through September 30, 2017.
Of 3980 patients, 2568 (64.5%) were treated at level I trauma centers and 1412 (35.5%) at level II centers. Baseline characteristics were similar between the 2 groups except for significantly worse GCS scores at admission in level I centers (P = .002). The rate of in-hospital mortality was 37.6% in level I centers vs 40.4% in level II centers (P = .08). Mean Functional Independence Measure (FIM) scores at discharge were significantly higher in level I (10.9 ± 5.5) than level II centers (9.8 ± 5.3; P < .005). In multivariate analysis, treatment at level II trauma centers was significantly associated with in-hospital mortality (odds ratio, 1.2; 95% confidence interval, 1.03-1.37; P = .01) and worse FIM scores (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = .001). Mean hospital and ICU length of stay were significantly longer in level I centers (P < .005).
This study showed superior functional outcomes and lower mortality rates in patients undergoing a neurosurgical procedure for severe TBI in level I trauma centers.
创伤性脑损伤（TBI）的发病率和死亡率极高。
在成熟的创伤系统中，评估接受开颅/去骨瓣减压术治疗严重 TBI 的患者在一级创伤中心是否比二级创伤中心预后更好。
数据从宾夕法尼亚创伤结局研究数据库中提取。纳入标准为 18 岁以上 GCS 评分<9 分的严重 TBI 患者，于 2002 年 1 月 1 日至 2017 年 9 月 30 日期间在宾夕法尼亚州接受开颅或去骨瓣减压术。
在 3980 例患者中，2568 例（64.5%）在一级创伤中心治疗，1412 例（35.5%）在二级创伤中心治疗。两组患者的基线特征相似，但一级中心入院时 GCS 评分明显更差（P=0.002）。一级中心的院内死亡率为 37.6%，二级中心为 40.4%（P=0.08）。一级中心出院时的平均功能独立性测量（FIM）评分明显更高（10.9±5.5），二级中心为 9.8±5.3（P<0.005）。多变量分析显示，在二级创伤中心治疗与院内死亡率显著相关（比值比，1.2；95%置信区间，1.03-1.37；P=0.01），与较差的 FIM 评分也显著相关（比值比，1.4；95%置信区间，1.1-1.7；P=0.001）。一级中心的平均住院时间和 ICU 住院时间明显更长（P<0.005）。
本研究表明，在一级创伤中心接受神经外科手术治疗严重 TBI 的患者，其功能结局更好，死亡率更低。
