非神经系统器官功能障碍对严重孤立性创伤性脑损伤结局的影响。
The impact of non-neurological organ dysfunction on outcomes in severe isolated traumatic brain injury.
机构信息
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2):405-410. doi: 10.1097/TA.0000000000002771.
INTRODUCTION
Organ dysfunction following traumatic brain injury (TBI) is common and has been associated with unpredictable outcomes. The aim of our study is to describe the incidence of non-neurological organ dysfunction (NNOD) and its impact on outcomes in patients with severe TBI admitted to our intensive care unit (ICU).
METHODS
We performed a 3-year (2015-2017) review of our Level 1 trauma center's prospectively maintained TBI database and included all adult (age ≥18y) patients with isolated severe TBI (head abbreviated injury severity (AIS) ≥3 and other AIS <3) and an ICU stay >48 hours. Organ dysfunction (OD) was measured by multiple organ dysfunction scores. Organ system failure was defined as a non-neurological component score of ≥3 on any day during the ICU stay. Outcomes measured were the incidence of NNOD and its effect on outcomes. Multivariate regression analysis was performed.
RESULTS
A total of 285 patients were included. The mean age was 48 ± 22 years, 72% were males, median [IQR] Glasgow Coma Scale (GCS) was 8[5-10], and median Injury Severity Score (ISS) was 17[10-26]. Epidural hematoma was the most common intracranial hemorrhage (49%) followed by subdural hematoma (46%). The overall incidence of NNOD was 33%, with the most common dysfunctional organ system being the respiratory (23%) followed by the cardiovascular (12%) and hepatic system (8%). The overall in-hospital mortality rate was 19% (NNOD:36% vs. No-NNOD:9%, p< 0.01). On regression analysis, NNOD was associated with higher in-hospital mortality (aOR: 2.0 [1.6-2.7]), discharge to skilled nursing facility (SNF) (aOR: 1.8 [1.4-2.2]), and Glasgow Outcome Scale-Extended (GOS-E) ≤4 (OR: 1.7 [1.3-2.3]) and p-values <0.01.
CONCLUSION
One in every three isolated severe TBI patients develop NNOD. NNOD is independently associated with worse outcomes. Understanding the mechanisms associated with NNOD in the setting of TBI may promote prevention practices and improve outcomes in TBI.
LEVEL OF EVIDENCE
Prognostic, level III.
简介
颅脑创伤（TBI）后器官功能障碍很常见，且与不可预测的结局相关。我们研究的目的是描述重症 TBI 患者入住重症监护病房（ICU）后非神经器官功能障碍（NNOD）的发生率及其对结局的影响。
方法
我们对本 3 年（2015-2017 年）间本 1 级创伤中心前瞻性 TBI 数据库进行回顾性研究，纳入所有成人（年龄≥18 岁）单纯性严重 TBI（头部简明损伤严重度评分（AIS）≥3 分，其他 AIS＜3 分）和 ICU 住院时间＞48 小时的患者。器官功能障碍（OD）通过多器官功能障碍评分进行测量。器官系统衰竭定义为 ICU 住院期间任意一天非神经成分评分≥3 分。测量的结局为 NNOD 的发生率及其对结局的影响。采用多变量回归分析。
结果
共纳入 285 例患者，平均年龄为 48±22 岁，72%为男性，中位（IQR）格拉斯哥昏迷评分（GCS）为 8[5-10]分，损伤严重程度评分（ISS）为 17[10-26]分。硬膜外血肿是最常见的颅内出血（49%），其次是硬膜下血肿（46%）。NNOD 的总体发生率为 33%，最常见的功能障碍器官系统为呼吸系统（23%），其次是心血管系统（12%）和肝脏系统（8%）。院内总体死亡率为 19%（NNOD：36% vs. 非-NNOD：9%，p＜0.01）。回归分析显示，NNOD 与更高的院内死亡率（aOR：2.0[1.6-2.7]）、入住康复护理机构（SNF）（aOR：1.8[1.4-2.2]）和格拉斯哥预后评分-扩展（GOS-E）≤4（OR：1.7[1.3-2.3]）相关，p 值均＜0.01。
结论
每 3 例单纯性严重 TBI 患者中就有 1 例发生 NNOD。NNOD 与更差的结局独立相关。了解 TBI 中与 NNOD 相关的机制可能有助于预防措施的实施，并改善 TBI 结局。
证据水平
预后，III 级。
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