Toida Chiaki, Muguruma Takashi, Gakumazawa Masayasu, Shinohara Mafumi, Abe Takeru, Takeuchi Ichiro, Morimura Naoto
Department of Disaster Medical Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan.
J Clin Med. 2021 Mar 4;10(5):1072. doi: 10.3390/jcm10051072.
Traumatic brain injury (TBI) is the major cause of mortality and morbidity in severely-injured patients worldwide. This retrospective nationwide study aimed to evaluate the age- and severity-related in-hospital mortality trends and mortality risks of patients with severe TBI from 2009 to 2018 to establish effective injury prevention measures. We retrieved information from the Japan Trauma Data Bank dataset between 2009 and 2018. The inclusion criteria for this study were patients with severe TBI defined as those with an Injury Severity Score ≥ 16 and TBI. In total, 31,953 patients with severe TBI (32.6%) were included. There were significant age-related differences in characteristics, mortality trend, and mortality risk in patients with severe TBI. The in-hospital mortality trend of all patients with severe TBI significantly decreased but did not improve for patients aged ≤ 5 years and with a Glasgow Coma Scale (GCS) score between 3 and 8. Severe TBI, age ≥ 65 years, fall from height, GCS score 3-8, and urgent blood transfusion need were associated with a higher mortality risk, and mortality risk did not decrease after 2013. Physicians should consider specific strategies when treating patients with any of these risk factors to reduce severe TBI mortality.
创伤性脑损伤（TBI）是全球重症患者死亡和发病的主要原因。这项全国性回顾性研究旨在评估2009年至2018年重度TBI患者与年龄和严重程度相关的院内死亡趋势及死亡风险，以制定有效的损伤预防措施。我们从日本创伤数据库中检索了2009年至2018年的信息。本研究的纳入标准为重度TBI患者，即损伤严重程度评分≥16且患有TBI的患者。总共纳入了31,953例重度TBI患者（占32.6%）。重度TBI患者在特征、死亡趋势和死亡风险方面存在显著的年龄相关差异。所有重度TBI患者的院内死亡趋势显著下降，但5岁及以下且格拉斯哥昏迷量表（GCS）评分为3至8分的患者死亡率并未改善。重度TBI、年龄≥65岁、高处坠落、GCS评分为3至8分以及急需输血与较高的死亡风险相关，且2013年后死亡风险并未降低。医生在治疗具有这些风险因素之一的患者时应考虑特定策略，以降低重度TBI的死亡率。
