Hanna Kamil, Hamidi Mohammad, Vartanyan Phillip, Henry Marion, Castanon Lourdes, Tang Andrew, Zeeshan Muhammad, Kulvatunyou Narong, Joseph Bellal
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
J Pediatr Surg. 2020 Aug;55(8):1590-1595. doi: 10.1016/j.jpedsurg.2020.01.051. Epub 2020 Feb 4.
Nonneurological organ dysfunction (NNOD) occurs after traumatic brain injury (TBI) and is associated with mortality. The aim of our study was to evaluate the prevalence of NNOD and its association with outcomes in pediatric patients with TBI. We hypothesized that NNOD is associated with worse outcomes in pediatric patients with severe TBI.
We performed a 4-year (2013-16) analysis of our prospectively maintained TBI database. All patients (age < 18) with an isolated-severe TBI (head-abbreviated injury scale: AIS ≥ 3 & extracranial-AIS < 3) were included. NNOD was measured using the pediatric multiple organ dysfunction (P-MOD) score. Outcomes were in-hospital mortality, Glasgow Outcome Scale-Extended (GOS-E), and adverse discharge disposition: rehabilitation or skilled nursing facility (SNF). Regression analysis was performed.
We analyzed 292 patients. Mean age was 11 ± 6 years, 57% were male and the mortality rate was 18.1%. The incidence of NNOD was 35%. The most common dysfunctional organ system was the respiratory (25%) followed by the cardiovascular (12%). On regression analysis, the presence of at least one NNOD was independently associated with in-hospital mortality (OR 2.1 [1.7-2.9]; p < 0.01), low GOS-E (OR 1.8 [1.5-2.3]; p < 0.01), and SNF disposition (OR 1.7 [1.2-2.1]; p < 0.01).
NNOD develops in one of every three severe TBI pediatric patients and is independently associated with adverse outcomes. Identification of NNOD in pediatric TBI and focusing on management of NNOD could improve outcomes.
III Prognostic.
创伤性脑损伤（TBI）后会出现非神经器官功能障碍（NNOD），且与死亡率相关。我们研究的目的是评估小儿TBI患者中NNOD的患病率及其与预后的关系。我们假设NNOD与重度小儿TBI患者的不良预后相关。
我们对前瞻性维护的TBI数据库进行了为期4年（2013 - 16年）的分析。纳入所有孤立性重度TBI患者（年龄<18岁，头部简明损伤定级标准：AIS≥3且颅外AIS<3）。使用小儿多器官功能障碍（P - MOD）评分来衡量NNOD。结局指标为住院死亡率、格拉斯哥扩展预后量表（GOS - E）以及不良出院处置情况：康复或熟练护理机构（SNF）。进行了回归分析。
我们分析了292例患者。平均年龄为11±6岁，57%为男性，死亡率为18.1%。NNOD的发生率为35%。最常见的功能障碍器官系统是呼吸系统（25%），其次是心血管系统（12%）。回归分析显示，至少存在一种NNOD与住院死亡率（比值比[OR] 2.1[1.7 - 2.9]；p<0.01）、低GOS - E（OR 1.8[1.5 - 2.3]；p<0.01）以及SNF处置情况（OR 1.7[1.2 - 2.1]；p<0.01）独立相关。
每三名重度小儿TBI患者中就有一人会发生NNOD，且与不良预后独立相关。识别小儿TBI中的NNOD并专注于NNOD的管理可能会改善预后。
III级预后性。
