Yengo-Kahn Aaron M, Patel Pious D, Kelly Patrick D, Wolfson Daniel I, Dawoud Fakhry, Ahluwalia Ranbir, Bonfield Christopher M, Guillamondegui Oscar D
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.
2Vanderbilt University School of Medicine, Nashville.
J Neurosurg. 2021 Mar 9;135(5):1560-1568. doi: 10.3171/2020.9.JNS201891. Print 2021 Nov 1.
Gunshot wounds to the head (GSWH) are devastating injuries with a grim prognosis. Several prognostic scores have been created to estimate mortality and functional outcome, including the so-called Baylor score, an uncomplicated scoring method based on bullet trajectory, patient age, and neurological status on admission. This study aimed to validate the Baylor score within a temporally, institutionally, and geographically distinct patient population.
Data were obtained from the trauma registry at a level I trauma center in the southeastern US. Patients with a GSWH in which dural penetration occurred were identified from data collected between January 1, 2009, and June 30, 2019. Patient demographics, medical history, bullet trajectory, intent of GSWH (e.g., suicide), admission vital signs, Glasgow Coma Scale score, pupillary response, laboratory studies, and imaging reports were collected. The Baylor score was calculated directly by using its clinical components. The ability of the Baylor score to predict mortality and good functional outcome (Glasgow Outcome Scale score 4 or 5) was assessed using the receiver operating characteristic curve and the area under the curve (AUC) as a measure of performance.
A total of 297 patients met inclusion criteria (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male). A total of 205 (69.0%) patients died, whereas 69 (23.2%) patients had good functional outcome. Overall, the Baylor score showed excellent discrimination of mortality (AUC = 0.88) and good functional outcome (AUC = 0.90). Baylor scores of 3-5 underestimated mortality. Baylor scores of 0, 1, and 2 underestimated good functional outcome.
The Baylor score is an accurate and easy-to-use prognostic scoring tool that demonstrated relatively stable performance in a distinct cohort between 2009 and 2019. In the current era of trauma management, providers may continue to use the score at the point of admission to guide family counseling and to direct investment of healthcare resources.
头部枪伤（GSWH）是具有严峻预后的毁灭性损伤。已经创建了几种预后评分来估计死亡率和功能结局，包括所谓的贝勒评分，这是一种基于子弹轨迹、患者年龄和入院时神经状态的简单评分方法。本研究旨在在美国东南部一个在时间、机构和地理上都不同的患者群体中验证贝勒评分。
数据来自美国东南部一家一级创伤中心的创伤登记处。从2009年1月1日至2019年6月30日收集的数据中识别出发生硬脑膜穿透的GSWH患者。收集患者的人口统计学信息、病史、子弹轨迹、GSWH的意图（如自杀）、入院生命体征、格拉斯哥昏迷量表评分、瞳孔反应、实验室检查和影像学报告。直接使用其临床组成部分计算贝勒评分。使用受试者工作特征曲线和曲线下面积（AUC）作为性能指标，评估贝勒评分预测死亡率和良好功能结局（格拉斯哥结局量表评分为4或5）的能力。
共有297例患者符合纳入标准（平均年龄38.0[标准差15.7]岁，73.4%为白人，85.2%为男性）。共有205例（69.0%）患者死亡，而69例（23.2%）患者功能结局良好。总体而言，贝勒评分在死亡率（AUC = 0.88）和良好功能结局（AUC = 0.90）方面显示出出色的区分能力。贝勒评分为3 - 5时低估了死亡率。贝勒评分为0、1和2时低估了良好功能结局。
贝勒评分是一种准确且易于使用的预后评分工具，在2009年至2019年期间的一个不同队列中表现出相对稳定的性能。在当前创伤管理时代，医疗服务提供者在入院时可继续使用该评分来指导家属咨询并指导医疗资源的投入。
