Chen Chih-Chi, Chen Carl P C, Chen Chien-Hung, Hsieh Yu-Wei, Chung Chia-Ying, Liao Chien-Hung
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan.
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, School of Medicine, Chang Gung University, 259, Sec1, WenHua First Road, Taoyuan 333, Taiwan.
Brain Sci. 2021 Jan 21;11(2):136. doi: 10.3390/brainsci11020136.
Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7-18 years with TBI were enrolled. Compared with mild/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.
创伤性脑损伤（TBI）是儿童死亡的主要原因。很少有研究关注患有TBI的学龄儿童。我们开展这项研究以确定重度TBI学龄儿童院内死亡的早期预测因素。在这项为期10年的观察性队列研究中，共纳入了550名7至18岁的TBI儿童。与轻度/中度TBI相比，重度TBI儿童年龄更大；更常见的损伤机制是交通事故；蛛网膜下腔出血（SAH）、硬膜下出血（SDH）、实质内出血、脑水肿等神经影像学表现更多，硬膜外出血（EDH）更少。我们研究中重度TBI儿童的院内死亡率为23%。多变量分析显示，跌倒、被物体击中、格拉斯哥昏迷量表运动评分（mGCS）、早期凝血功能障碍和SAH是院内死亡的独立预测因素。我们得出结论，重度TBI学龄儿童死亡率较高。包括跌倒和被击中的损伤机制、较低的初始mGCS、早期凝血功能障碍和SAH在内的临床特征可预测院内死亡。
