Ram Kodanda, VaraPrasad Kadali, Krishna Murali K, Kannan Nithya, Sundar Venkataraman, Joseph Mathew, Sinha Virendar D, Shukla Dhaval, Gururaj Gopalakrishnan, Narayan Raj K, Pattisapu Jogi V, Vavilala Monica S
Department of Neurosurgery, King George Hospital, Andhra Medical College Visakhapatnam, KGH, Opp KGH OP Gate, Maharani Peta, Visakhapatnam, Andhra Pradesh, India.
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.
World Neurosurg X. 2019 Feb 13;2:100020. doi: 10.1016/j.wnsx.2019.100020. eCollection 2019 Apr.
Strategies to improve traumatic brain injury (TBI) outcomes in India are ill defined. The objective of this study was to examine baseline prehospital (PH) factors associated with outcomes from the Andhra Pradesh Traumatic Brain Injury Project.
We conducted a prospective observational cohort study of adult patients with TBI admitted to the primary referral hospital. Modes of injury, prehospital care and transport, and factors associated with increased in-hospital mortality were evaluated. Poisson regression with robust error variance and adjusted attributable risk percent estimates determined factors associated with outcomes.
A total of 447 adults (38% with mild TBI, 30% with moderate TBI, and 32% with severe TBI; 81% men) with isolated TBI (89%) from road traffic accidents (48.1%) or falls (46.5%) were enrolled. Of the patients, 45.7% were transported by ambulance, 61% had scalp/facial bleeding, 11% had respiratory distress, and 7% had cervical spine stabilization. Of these, 25.3% died and 34% had unfavorable outcomes. Among 335 direct admits, 45% traveled more than 50 km and nearly 20% traveled more than 100 km. Bleeding was associated with higher mortality (adjusted relative risk [aRR], 1.56; 95% confidence interval [CI], 1.05-2.31) and unfavorable outcome (aRR, 1.60; 95% CI, 1.18-2.17). Of the patients, 45 (31%) with severe TBI received PH airway management prior to definitive treatment, and respiratory distress was associated with unfavorable discharge outcomes (aRR, 1.23; 95% CI, 1.00-1.51).
Patients with TBI often received treatment far away from injury, bypassing closer hospitals. Scalp/facial bleeding was common and associated with unfavorable outcomes. Ambulance use was infrequent, and few patients received PH airway management, hemorrhage control, or cervical spine stabilization when needed.
印度改善创伤性脑损伤（TBI）预后的策略尚不明确。本研究的目的是调查与安得拉邦创伤性脑损伤项目预后相关的院前（PH）基线因素。
我们对入住一级转诊医院的成年TBI患者进行了一项前瞻性观察队列研究。评估了损伤方式、院前护理和转运情况，以及与院内死亡率增加相关的因素。采用具有稳健误差方差的泊松回归和调整后的归因风险百分比估计来确定与预后相关的因素。
共纳入447例成年孤立性TBI患者（38%为轻度TBI，30%为中度TBI，32%为重度TBI；81%为男性），损伤原因包括道路交通事故（48.1%）或跌倒（46.5%）。患者中，45.7%由救护车转运，61%有头皮/面部出血，11%有呼吸窘迫，7%进行了颈椎固定。其中，25.3%死亡，34%预后不良。在335例直接入院患者中，45%行程超过50公里，近20%行程超过100公里。出血与较高的死亡率（调整后相对风险[aRR]，1.56；95%置信区间[CI]，1.05 - 2.31）和不良预后（aRR，1.60；95%CI，1.18 - 2.17）相关。患者中，45例（31%）重度TBI患者在确定性治疗前接受了院前气道管理，呼吸窘迫与不良出院结局相关（aRR，1.23；95%CI，1.00 - 1.51）。
TBI患者常远离受伤地接受治疗，绕过了更近的医院。头皮/面部出血常见且与不良预后相关。救护车使用率低，很少有患者在需要时接受院前气道管理、出血控制或颈椎固定。
