Chen Chien-Hung, Hsieh Yu-Wei, Huang Jen-Fu, Hsu Chih-Po, Chung Chia-Ying, Chen Chih-Chi
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan.
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
J Pers Med. 2021 Dec 9;11(12):1339. doi: 10.3390/jpm11121339.
(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients' clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate ( < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia ( = 0.011), a lower mGCS score ( < 0.001), a longer initial prothrombin time ( < 0.013), hyperglycemia ( = 0.017), and a higher Rotterdam CT score ( < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28-3.14, = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31-5.06, = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.
（1）背景：道路交通事故（RTAs）是儿童创伤性脑损伤（TBI）的主要原因，且与高死亡率相关。很少有研究聚焦于与道路交通事故相关的儿童创伤性脑损伤。我们开展这项研究以分析与道路交通事故相关的儿童创伤性脑损伤的临床特征，并确定重度创伤性脑损伤患儿院内死亡的早期预测因素。（2）方法：在这项为期15年的观察性队列研究中，共纳入618例与道路交通事故相关的儿童创伤性脑损伤患者。我们收集了患者在急诊科（ED）初次就诊时的临床特征，包括性别、年龄、道路使用者类型、格拉斯哥昏迷量表运动评分（mGCS）、体温、血压、血糖水平、初始凝血酶原时间以及颅内计算机断层扫描（CT）鹿特丹评分，作为潜在的死亡预测因素。（3）结果：与表现为轻度/中度与道路交通事故相关的创伤性脑损伤的儿童相比，重度与道路交通事故相关的创伤性脑损伤儿童年龄更大，死亡率更高（<0.001）。重度与道路交通事故相关的创伤性脑损伤儿童的院内死亡率为15.6%。与存活儿童相比，院内死亡儿童出现体温过低的发生率更高（=0.011）、mGCS评分更低（<0.001）、初始凝血酶原时间更长（<0.013）、高血糖（=0.017）以及鹿特丹CT评分更高（<0.001）。多因素分析显示，mGCS评分（调整后的比值比（OR）：2.00，95%置信区间（CI）：1.28 - 3.14，=0.002）和鹿特丹CT评分（调整后的OR：2.58，95%CI：1.31 - 5.06，=0.006）是院内死亡的独立预测因素。（4）结论：与道路交通事故相关的重度创伤性脑损伤儿童死亡率高。在脑部CT分析中，最初表现为体温过低、mGCS评分较低、凝血酶原时间延长、高血糖以及鹿特丹CT评分较高的患者与院内死亡相关。mGCS和鹿特丹CT评分可独立预测院内死亡。
