Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Sci Rep. 2020 Jan 15;10(1):400. doi: 10.1038/s41598-019-57334-6.
Traumatic brain injury (TBI) is the leading cause of pediatric morbidity and mortality worldwide, and half of all fatalities occur in infants aged less than 1 year. We analyzed 129 infants diagnosed with TBI complicated with intracranial hemorrhage confirmed by brain computed tomography. We defined delta hemoglobin (ΔHB) as nadir HB - age specific mean HB, and the ratio of HB (%) as ΔHB/age specific mean HB x 100. Infants with poor neurologic outcomes had a lower admission HB and ΔHB (p < 0.05). The in-hospital mortality rate was 10.1% (13 infants), and the infants who died had a significantly lower ΔHB ratio compared to the survivors. The area under the receiving operating characteristic curve (AUC) of initial Glasgow Coma Score (GCS) in predicting neurologic outcomes was higher than that of ratio of ΔHB (0.881 v.s 0.859). In multivariate logistic regression analysis with the optimal cutoff ratio of ΔHB, it remained an independent predictor for in-hospital mortality and poor neurologic outcomes at discharge and at 6 months. AUC analysis for the ratio of ΔHB for poor neurologic outcomes in infants aged from 0-6 months was 0.85 and the optimal cutoff was -30.7% (sensitivity, 69%; specificity, 92%; positive likelihood ratio (LR), 8.24; negative likelihood ratio (LR), 0.34); the AUC was 0.88 in infants aged from 6-12 months and the optimal cutoff was -20.6% (sensitivity, 89%; specificity, 79%; LR, 4.13; LR, 0.15).
创伤性脑损伤（TBI）是全球导致儿童发病率和死亡率的主要原因，其中一半的死亡发生在年龄小于 1 岁的婴儿中。我们分析了 129 例经脑计算机断层扫描证实合并颅内出血的 TBI 婴儿。我们将 ΔHB 定义为最低 HB-年龄特异性平均 HB，HB（%）的比值为 ΔHB/年龄特异性平均 HB×100。神经功能预后不良的婴儿入院时 HB 和 ΔHB 较低（p<0.05）。住院期间的死亡率为 10.1%（13 例），死亡婴儿的 ΔHB 比值明显低于存活婴儿。初始格拉斯哥昏迷评分（GCS）预测神经功能预后的受试者工作特征曲线（ROC）下面积（AUC）高于 ΔHB 比值（0.881 对 0.859）。在以 ΔHB 比值最佳截断值进行的多变量逻辑回归分析中，它仍然是住院期间死亡率和出院时及 6 个月时不良神经功能结局的独立预测因素。对 0-6 个月龄婴儿的 ΔHB 比值进行不良神经功能结局的 AUC 分析为 0.85，最佳截断值为-30.7%（敏感性，69%；特异性，92%；阳性似然比（LR），8.24；阴性似然比（LR），0.34）；在 6-12 个月龄婴儿中，AUC 为 0.88，最佳截断值为-20.6%（敏感性，89%；特异性，79%；LR，4.13；LR，0.15）。
