联合烧伤和创伤性脑损伤后的死亡率：美国外科医师学院国家创伤数据库分析。
Mortality following combined burn and traumatic brain injuries: An analysis of the national trauma data bank of the American College of Surgeons.
机构信息
Departments of Neurological Surgery and Neurology, University of California, Davis, 4860 Y St, Suite 3740, Sacramento, CA, 95817, United States.
Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, 2921 Stockton Blvd, Suite 1400, Sacramento, CA, 95817, United States.
出版信息
Burns. 2020 Sep;46(6):1289-1296. doi: 10.1016/j.burns.2020.06.022. Epub 2020 Jul 3.
BACKGROUND
Severe burn and traumatic brain injuries (TBI) lead to significant mortality, and combined burn-TBI injuries may predispose towards even worse outcomes. The purpose of this study was to investigate the mortality of patients with burn, burn with non-TBI trauma, and combined burn/TBI to determine if combined injury portends a worse outcome.
METHODS
We obtained the National Trauma Data Bank from 2007 to 2012, identifying 32,334 patients with burn related injuries, dividing this cohort into three injury types: BURN ONLY, BURN with TRAUMA/NO TBI, and BURN with TBI. For each patient, demographic data was obtained, including age, gender, presence of trauma, TBI, or inhalation injury, burn total body surface area (TBSA), Glasgow Coma Scale, Injury Severity Score, and mortality. Multivariable logistic regression was performed.
RESULTS
Age, gender, and TBSA were similar across the three injury groups, but the incidence of inhalation injury was doubled in the BURN with TRAUMA/NO TBI (15.4 %) and BURN with TBI (15.3 %) groups when compared to the BURN ONLY (7.2 %) group. Mortality differed across injury categories after adjusting for age, TBSA, and inhalation injury. Increased mortality was seen in BURN with TRAUMA/NO TBI versus BURN ONLY (OR = 1.27 [1.06, 1.53]) and was higher when comparing BURN with TBI versus BURN ONLY (OR = 4.22 [2.85, 6.18]). BURN with TBI also had higher mortality when compared to BURN with TRAUMA/NO TBI (OR = 3.33 [2.30, 4.82]). The logs odds of mortality also increased with increasing age, TBSA and presence of inhalation injury.
DISCUSSION
This analysis of the NTDB suggests that mortality following burn-related injuries may be higher when burn injury is combined with TBI when compared to burns with other trauma, even after correcting for age, TBSA, and inhalation injury. Further clinical and laboratory research is needed to validate these findings and better understand how to optimize combined TBI and burn injury treatment.
背景
严重烧伤和创伤性脑损伤（TBI）导致高死亡率，而烧伤合并 TBI 可能导致更差的结局。本研究旨在探讨烧伤患者、烧伤合并非 TBI 创伤患者和烧伤合并 TBI 患者的死亡率，以确定合并损伤是否预示着更差的结果。
方法
我们从 2007 年至 2012 年获得了国家创伤数据库，确定了 32334 名烧伤相关损伤患者，将该队列分为三种损伤类型：仅烧伤、烧伤伴创伤/无 TBI 和烧伤伴 TBI。对每位患者进行了人口统计学数据的获取，包括年龄、性别、创伤、TBI 或吸入性损伤的存在、烧伤总面积（TBSA）、格拉斯哥昏迷量表、损伤严重程度评分和死亡率。进行了多变量逻辑回归分析。
结果
年龄、性别和 TBSA 在三组损伤中相似，但与仅烧伤（7.2%）组相比，烧伤伴创伤/无 TBI（15.4%）和烧伤伴 TBI（15.3%）组的吸入性损伤发生率增加了一倍。调整年龄、TBSA 和吸入性损伤后，三组损伤的死亡率不同。与仅烧伤相比，烧伤伴创伤/无 TBI 死亡率增加（OR=1.27[1.06，1.53]），与仅烧伤相比，烧伤伴 TBI 死亡率更高（OR=4.22[2.85，6.18]）。与烧伤伴创伤/无 TBI 相比，烧伤伴 TBI 的死亡率也更高（OR=3.33[2.30，4.82]）。随着年龄、TBSA 和吸入性损伤的增加，死亡率的对数优势也随之增加。
讨论
本研究对 NTDB 的分析表明，与烧伤伴其他创伤相比，烧伤相关损伤后死亡率可能更高，当烧伤合并 TBI 时，即使校正年龄、TBSA 和吸入性损伤后也是如此。需要进一步的临床和实验室研究来验证这些发现，并更好地了解如何优化合并 TBI 和烧伤损伤的治疗。
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