小儿轻度颅脑损伤后早期认知障碍常见。
Early cognitive impairment is common in pediatric patients following mild traumatic brain injury.
机构信息
From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery (M.E.K., P.D., K.I.B., K.R., M.L., J.N.), University of California, Irvine, Orange, CA; Center for Statistical Consulting (K.A.K.), University of California, Irvine; and Department of Surgery, Los Angeles, CA (K.I.).
出版信息
J Trauma Acute Care Surg. 2021 Nov 1;91(5):861-866. doi: 10.1097/TA.0000000000003266.
INTRODUCTION
The incidence and factors related to early cognitive impairment (ECI) after mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) are unknown. Prior data in the adult population demonstrated an ECI incidence of 51% after mTBI and strong correlation with initial Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category. Therefore, we hypothesized that ECI is common after mTBI in PTPs and associated with initial GCS and BIG category.
METHODS
A single-center, retrospective review of PTPs (age, 8-17 years) from 2015 to 2019 with intracranial hemorrhage and mTBI (GCS score, 13-15) was performed. Primary outcome was ECI, defined as Ranchos Los Amigos score less than 8. Comparisons between ECI and non-ECI groups regarding Injury Severity Score (ISS), demographics, and cognitive and clinical outcomes were evaluated using χ2 statistics and Wilcoxon rank sum tests. Odds of ECI were evaluated using multivariable logistic regression.
RESULTS
From 47 PTPs with mTBI, 18 (38.3%) had ECI. Early cognitive impairment patients had a higher ISS than non-ECI patients (19.7 vs. 12.6, p = 0.003). Injuries involving motor vehicles were more often related to ECI than non-auto-involved mechanisms (55% vs. 15%, p = 0.005). Lower GCS score (odds ratio [OR], 6.60; 95% confidence interval [CI], 1.34-32.51, p = 0.02), higher ISS (OR, 1.12; 95% CI, 1.01-1.24; p = 0.030), and auto-involved injuries (OR, 6.06; 95% CI, 1.15-31.94; p = 0.030) were all associated with increased risk of ECI. There was no association between BIG category and risk of ECI (p > 0.05).
CONCLUSION
Nearly 40% of PTPs with mTBI suffer from ECI. Lower initial GCS score, higher ISS, and autoinvolved mechanism of injury were associated with increased risk of ECI. Brain Injury Guidelines category was not associated with ECI in pediatric patients.
LEVEL OF EVIDENCE
Prognostic study, Level III.
简介
小儿创伤患者（PTP）轻度创伤性脑损伤（mTBI）后早期认知障碍（ECI）的发生率和相关因素尚不清楚。成人人群中的先前数据显示，mTBI 后 ECI 的发生率为 51%，与初始格拉斯哥昏迷量表（GCS）和脑损伤指南（BIG）分类有很强的相关性。因此，我们假设 ECI 在 PTP 后 mTBI 中很常见，与初始 GCS 和 BIG 分类相关。
方法
对 2015 年至 2019 年期间因颅内出血和 mTBI（GCS 评分 13-15）而入住我院的 8-17 岁 PTP 进行了单中心回顾性研究。主要结局为 Ranchos Los Amigos 评分<8 的 ECI。使用卡方检验和 Wilcoxon 秩和检验比较 ECI 组和非 ECI 组之间的损伤严重程度评分（ISS）、人口统计学、认知和临床结局。使用多变量逻辑回归评估 ECI 的可能性。
结果
在 47 例 mTBI 的 PTP 中，有 18 例（38.3%）发生 ECI。早期认知障碍患者的 ISS 高于非 ECI 患者（19.7 比 12.6，p=0.003）。涉及机动车的损伤比非机动车损伤更常与 ECI 相关（55%比 15%，p=0.005）。较低的 GCS 评分（比值比[OR]，6.60；95%置信区间[CI]，1.34-32.51，p=0.02）、较高的 ISS（OR，1.12；95%CI，1.01-1.24；p=0.030）和机动车损伤（OR，6.06；95%CI，1.15-31.94；p=0.030）均与 ECI 风险增加相关。BIG 类别与 ECI 风险之间无关联（p>0.05）。
结论
近 40%的 mTBI 的 PTP 患有 ECI。初始 GCS 评分较低、ISS 较高和机动车损伤机制与 ECI 风险增加相关。BIG 类别与小儿患者的 ECI 无关。
证据水平
预后研究，III 级。
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