Department of Surgery, Division of Trauma and Acute Care Surgery, Kendall Regional Medical Center, Miami, Florida.
Department of Surgery, Division of Trauma and Acute Care Surgery, Kendall Regional Medical Center, Miami, Florida.
J Surg Res. 2021 Aug;264:194-198. doi: 10.1016/j.jss.2021.02.025. Epub 2021 Apr 7.
Traumatic Brain Injury (TBI) is a leading cause of mortality in the trauma population. Accurate prognosis remains a challenge. Two common Computed Tomography (CT)-based prognostic models include the Marshall Classification and the Rotterdam CT Score. This study aims to determine the utility of the Marshall and Rotterdam scores in predicting mortality for adult patients in coma with severe TBI.
Retrospective review of our Level 1 Trauma Center's registry for patients ≥ 18 years of age with blunt TBI and a Glasgow Coma Scale (GCS) of 3-5, with no other significant injuries. Admission Head CT was evaluated for the presence of extra-axial blood (SDH, EDH, SAH, IVH), intra-axial blood (contusions, diffuse axonal injury), midline shift and mass effect on basilar cisterns. Rotterdam and Marshall scores were calculated for all patients; subsequently patients were divided into two groups according to their score (< 4, ≥ 4).
106 patients met inclusion criteria; 75.5% were males (n = 80) and 24.5% females (n = 26). The mean age was 52. The odds ratio (OR) of dying from severe TBI for patients in coma with a Rotterdam score of ≥ 4 compared to < 4 was OR = 17 (P < 0.05). The odds of dying from severe TBI for patients in coma with a Marshall score of ≥ 4 versus < 4 was OR = 11 (P < 0.05).
Higher scores in the Marshall classification and the Rotterdam system are associated with increased odds of mortality in adult patients in come from severe TBI after blunt injury. The results of our study support these scoring systems and revealed that a cutoff score of < 4 was associated with improved survival.
创伤性脑损伤（TBI）是创伤人群中导致死亡的主要原因。准确的预后仍然是一个挑战。两种常见的基于计算机断层扫描（CT）的预后模型包括马歇尔分类和鹿特丹 CT 评分。本研究旨在确定马歇尔和鹿特丹评分在预测昏迷中重度 TBI 成年患者死亡率中的作用。
回顾性分析我院 1 级创伤中心登记的年龄≥ 18 岁、格拉斯哥昏迷量表（GCS）评分为 3-5 分、无其他明显损伤的钝性 TBI 患者。入院时头颅 CT 评估有无外脑室内血（硬膜下血肿、脑内血肿、蛛网膜下腔出血、脑室内出血）、脑内出血（挫伤、弥漫性轴索损伤）、中线移位和基底池的肿块效应。对所有患者计算鹿特丹和马歇尔评分；随后根据评分（< 4，≥ 4）将患者分为两组。
106 例患者符合纳入标准；75.5%为男性（n = 80），24.5%为女性（n = 26）。平均年龄为 52 岁。昏迷中重度 TBI 患者鹿特丹评分≥ 4 分与< 4 分相比，死亡的优势比（OR）为 17（P < 0.05）。昏迷中重度 TBI 患者马歇尔评分≥ 4 分与< 4 分相比，死亡的优势比（OR）为 11（P < 0.05）。
马歇尔分类和鹿特丹系统评分较高与钝性创伤后昏迷中重度 TBI 成年患者的死亡几率增加相关。我们的研究结果支持这些评分系统，并表明< 4 的截点与生存率提高相关。
