School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.
Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4481-4488. doi: 10.1007/s00068-021-01841-7. Epub 2021 Nov 27.
Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients.
All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference.
259,399 patients met the study's inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01-1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05-1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11-1.90), p = 0.006], compared to RCRI 0.
An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.
创伤性脑损伤（TBI）仍然是全球范围内导致死亡率和发病率的主要原因。由于心血管事件是严重 TBI 后最常见的颅外死亡原因之一，因此修订后的心脏风险指数（RCRI）可能有助于对该患者人群进行风险分层。本研究旨在确定 RCRI 与孤立性严重 TBI 患者住院内死亡之间的关系。
纳入 2013 年至 2017 年期间在 TQIP 数据库中登记的所有患有孤立性严重 TBI 的成年患者，定义为头部 AIS≥3 且所有其他身体部位 AIS≤1。如果头部 AIS 为 6，则排除患者。使用泊松回归模型分析不同 RCRI 评分（0、1、2、3、≥4）与住院内死亡率之间的关系，采用稳健标准误差，同时调整潜在混杂因素，以 RCRI 0 为参考。
259399 名患者符合研究纳入标准。RCRI 2 与死亡率风险增加 6%相关[调整后的发病率比（95%CI）1.06（1.01-1.12），p=0.027]，RCRI 3 与死亡率风险增加 17%相关[调整后的发病率比（95%CI）1.17（1.05-1.31），p=0.004]，RCRI≥4 与住院内死亡率风险增加 46%相关[调整后的发病率比（95%CI）1.46（1.11-1.90），p=0.006]，与 RCRI 0 相比。
在患有孤立性严重创伤性脑损伤的患者中，升高的 RCRI≥2 与住院内死亡率风险增加显著相关。该指数的简单性和床边适用性使其成为该患者人群风险分层的有吸引力的选择。
