Bick Heather, Wasfie Tarik, Labond Virginia, Hella Jennifer R, Pearson Eric, Barber Kimberly R
Ascension Genesys Hospital, Emergency Department, Grand Blanc, MI, United States of America.
Ascension Genesys Hospital, Department of Trauma Services, Grand Blanc, MI, United States of America.
Am J Emerg Med. 2022 Jan;51:354-357. doi: 10.1016/j.ajem.2021.11.005. Epub 2021 Nov 8.
Current trauma activation guidelines do not clearly address age as a risk factor when leveling trauma patients. Glasgow coma scale (GCS) and mode of injury play a major role in leveling trauma patients. We studied the above relationship in our elderly patients presenting with traumatic head injury.
This study was a retrospective analysis of patients who presented to the emergency department with traumatic brain injuries. We classified the 270 patients into two groups. Group A was 64 years and younger, and group B was 65 years and older. Their GCS, ISS, age, sex, comorbidities, and anticoagulant use were abstracted. The primary outcome was mortality and length of stay. The groups were compared using an independent student's t-test and Chi-square analysis. The Cox regression analysis was used to analyze differences in the outcome while adjusting for the above factors.
There were 140 patients in group A, and 130 patients in group B who presented to the ED with a GCS of 14-15 and an ISS of below 15. The mean ISS significantly differed between group A (6.2 ± 6.8) vs (7.9 ± 3.2) in group B (p < 0.0001). The most common diagnosis in group A was concussion (57.3%), while in group B was subdural and subarachnoid hemorrhage (55%). In group B, 13.8% presented as a level one or level two trauma activation. The mean hospital and intensive care stay for group A was 2.1 (±1.9) days and 0.9 (±1.32) days, respectively, versus 4.2 (±3.04) days and 2.4 (±2.02 days) for the elderly group B. Mortality in group A was zero and in group B was 3.8%. Cox regression analysis showed age as an independent predictor of death as well as length of stay.
Elderly traumatic brain injury patients presenting to the ED with minor trauma and high GCS should be triaged at a higher level in most cases.
当前的创伤激活指南在对创伤患者进行分级时，并未明确将年龄作为一个风险因素加以考量。格拉斯哥昏迷量表（GCS）和损伤方式在创伤患者分级中起主要作用。我们对我院收治的老年创伤性脑损伤患者的上述关系进行了研究。
本研究是对急诊科收治的创伤性脑损伤患者的回顾性分析。我们将270例患者分为两组。A组年龄在64岁及以下，B组年龄在65岁及以上。提取他们的GCS、损伤严重度评分（ISS）、年龄、性别、合并症及抗凝剂使用情况。主要结局指标为死亡率和住院时间。采用独立样本t检验和卡方分析对两组进行比较。使用Cox回归分析在对上述因素进行校正的同时分析结局差异。
A组有140例患者，B组有130例患者因GCS为14 - 15且ISS低于15而就诊于急诊科。A组的平均ISS（6.2±6.8）与B组（7.9±3.2）相比有显著差异（p<0.0001）。A组最常见的诊断是脑震荡（57.3%），而B组是硬膜下和蛛网膜下腔出血（55%）。在B组中，13.8%的患者表现为一级或二级创伤激活。A组的平均住院时间和重症监护时间分别为2.1（±1.9）天和0.9（±1.32）天，而老年B组分别为4.2（±3.04）天和2.4（±2.02）天。A组死亡率为零，B组为3.8%。Cox回归分析显示年龄是死亡及住院时间的独立预测因素。
大多数情况下，因轻度创伤和高GCS而就诊于急诊科的老年创伤性脑损伤患者应进行更高级别的分诊。
