Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.
Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan; Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
Am J Emerg Med. 2021 Aug;46:78-83. doi: 10.1016/j.ajem.2021.03.020. Epub 2021 Mar 11.
To identify the association between skull fracture (SF) and in-hospital mortality in patients with severe traumatic brain injury (TBI).
This multicenter cohort study included a retrospective analysis of data from the Japan Trauma Data Bank (JTDB). JTDB is a nationwide, prospective, observational trauma registry with data from 235 hospitals. Adult patients with severe TBI (Glasgow Coma Scale <9, head Abbreviated Injury Scale (AIS) ≥ 3, and any other AIS < 3) who were registered in the JTDB between January 2004 and December 2017 were included in the study. Patients who (a) were < 16 years old, (b) developed cardiac arrest before or at hospital arrival, and (c) had burns and penetrating injuries were excluded from the study. In-hospital mortality was the primary outcome assessed. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) of SF and their 95% confidence intervals (CIs) for in-hospital mortality.
A total of 9607 patients were enrolled [median age: 67 (interquartile range: 50-78) years] in the study. Among those patients, 3574 (37.2%) and 6033 (62.8%) were included in the SF and non-SF groups, respectively. The overall in-hospital mortality rate was 44.1% (4238/9607). A multivariate analysis of the association between SF and in-hospital mortality yielded a crude OR of 1.63 (95% CI: 1.47-1.80). A subgroup analysis of the association of skull vault fractures, skull base fractures, and both fractures together with in-hospital mortality yielded adjusted ORs of 1.60 (95% CI: 1.42-1.98), 1.40 (95% CI: 1.16-1.70), and 2.14 (95% CI: 1.74-2.64), respectively, relative to the non-SF group.
This observational study showed that SF is associated with in-hospital mortality among patients with severe TBI. Furthermore, patients with both skull base and skull vault fractures were associated with higher in-hospital mortality than those with only one of these injuries.
目的是确定颅骨骨折（SF）与严重创伤性脑损伤（TBI）患者住院死亡率之间的关系。
这是一项多中心队列研究，对日本创伤数据库（JTDB）的数据进行了回顾性分析。JTDB 是一个全国性的、前瞻性的、观察性的创伤登记处，数据来自 235 家医院。纳入标准为：年龄≥16 岁、Glasgow 昏迷量表评分<9 分、头部简明损伤量表（AIS）≥3 分、且其他任何部位 AIS<3 分的严重 TBI 患者。登记在 JTDB 中的患者在 2004 年 1 月至 2017 年 12 月期间发生的患者。排除标准为：（a）年龄<16 岁；（b）在入院前或入院时发生心脏骤停；（c）有烧伤和穿透性损伤。住院死亡率是评估的主要结局。采用多变量逻辑回归分析计算 SF 与住院死亡率之间的调整比值比（OR）及其 95%置信区间（CI）。
共纳入 9607 例患者[中位年龄：67（四分位距：50-78）岁]。其中 3574 例（37.2%）和 6033 例（62.8%）患者分别归入 SF 组和非 SF 组。总体住院死亡率为 44.1%（4238/9607）。SF 与住院死亡率之间的多变量分析得出的粗 OR 为 1.63（95%CI：1.47-1.80）。SF 与颅盖骨骨折、颅底骨折和两者均骨折与住院死亡率之间关系的亚组分析得出的调整 OR 分别为 1.60（95%CI：1.42-1.98）、1.40（95%CI：1.16-1.70）和 2.14（95%CI：1.74-2.64）。
这项观察性研究表明，SF 与严重 TBI 患者的住院死亡率相关。此外，与仅有一种颅骨损伤的患者相比，同时患有颅底和颅盖骨骨折的患者住院死亡率更高。
