Accident and Emergency Department, Complejo Hospitalario de Navarra, Health service of Navarra-Osasunbidea, 31011, Pamplona, Spain.
Trauma Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Eur J Trauma Emerg Surg. 2021 Oct;47(5):1429-1436. doi: 10.1007/s00068-019-01091-8. Epub 2019 Feb 12.
To compare the profile, treatment and outcome of elderly patients with severe traumatic brain injuries (TBI) between southern Finland and Navarra (Spain).
Data collected from, 2010 to 2015, in the Major Trauma Registry of Navarra (MTR-N) and the Helsinki Trauma Registry (HTR) were compared. Patients with New Injury Severity Score (NISS) ≥ 16 and age ≥ 65 with isolated severe TBI were considered. Patients who had been admitted to the hospital ≥ 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Outcome was defined by 30-day hospital mortality. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Other compared data included demographics, injury mechanism, pre-hospital and hospital treatment, and time intervals.
A total of 305 (MTR-N) and 137 (HTR) patients were included in the outcome analysis. The standardized mortality ratio with 95% confidence interval was for MTR-N 1.4 (1.1-1.6) and for HTR 0.8 (0.6-1.1). Patients in Navarra were older (average 79.7 vs. 75.0) while in southern Finland the percentage of pre-hospital intubation in patients with GCS ≤ 8 (75.0% vs 50.0%) and ICU admission (72.2% vs 22.0%) were higher.
The better adjusted outcome of elderly patients with severe TBI in southern Finland in comparison to Navarra could be due to higher rate of pre-hospital intubation and/or higher rate of ICU admissions in southern Finland. Increasing number of elderly patients with severe TBI necessitate uniformly accepted protocols in pre- and in-hospital management.
比较芬兰南部和纳瓦拉（西班牙）老年严重创伤性脑损伤（TBI）患者的特征、治疗和结局。
对比分析 2010 年至 2015 年纳瓦拉重大创伤登记处（MTR-N）和赫尔辛基创伤登记处（HTR）收集的数据。纳入标准为新损伤严重程度评分（NISS）≥16 且年龄≥65 岁、单纯严重 TBI 的患者。排除创伤后入院时间≥24 小时、院前已宣布死亡或因上吊、溺水或烧伤受伤的患者。结局定义为 30 天院内死亡率。采用修订创伤严重程度分类评分 II（RISC II）计算预期死亡率。其他比较数据包括人口统计学、损伤机制、院前和院内治疗以及时间间隔。
共有 305 例（MTR-N）和 137 例（HTR）患者纳入结局分析。MTR-N 的标准化死亡率比及其 95%置信区间为 1.4（1.1-1.6），HTR 为 0.8（0.6-1.1）。纳瓦拉的患者年龄较大（平均 79.7 岁 vs. 75.0 岁），而芬兰南部的院前 GCS≤8 患者气管插管比例（75.0% vs. 50.0%）和 ICU 入院率（72.2% vs. 22.0%）更高。
与纳瓦拉相比，芬兰南部老年严重 TBI 患者的调整后结局更好，这可能是由于芬兰南部院前气管插管和/或 ICU 入院率较高所致。越来越多的老年严重 TBI 患者需要统一接受的院前和院内管理方案。
