From the Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital.
Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai.
J Comput Assist Tomogr. 2022;46(5):800-807. doi: 10.1097/RCT.0000000000001343. Epub 2022 May 30.
In this study, we investigate the preoperative and postoperative computed tomography (CT) scores in severe traumatic brain injury (TBI) patients undergoing decompressive craniectomy (DC) and compare their predictive accuracy.
Univariate and multivariate logistic regression analyses were used to determine the relationship between CT score (preoperative and postoperative) and mortality at 30 days after injury. The discriminatory power of preoperative and postoperative CT score was assessed by the area under the receiver operating characteristic curve (AUC).
Multivariate logistic regression analysis adjusted for the established predictors of TBI outcomes showed that preoperative Rotterdam CT score (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.13-11.50; P = 0.030), postoperative Rotterdam CT score (OR, 4.17; 95% CI, 1.63-10.66; P = 0.003), preoperative Stockholm CT score (OR, 3.41; 95% CI, 1.42-8.18; P = 0.006), postoperative Stockholm CT score (OR, 4.50; 95% CI, 1.60-12.64; P = 0.004), preoperative Helsinki CT score (OR, 1.44; 95% CI, 1.03-2.02; P = 0.031), and postoperative Helsinki CT score (OR, 2.55; 95% CI, 1.32-4.95; P = 0.005) were significantly associated with mortality. The performance of the postoperative Rotterdam CT score was superior to the preoperative Rotterdam CT score (AUC, 0.82-0.97 vs 0.71-0.91). The postoperative Stockholm CT score was superior to the preoperative Stockholm CT score (AUC, 0.76-0.94 vs 0.72-0.92). The postoperative Helsinki CT score was superior to the preoperative Helsinki CT score (AUC, 0.88-0.99 vs 0.65-0.87).
In conclusion, assessing the CT score before and after DC may be more precise and efficient for predicting early mortality in severe TBI patients who undergo DC.
本研究旨在探讨行去骨瓣减压术（DC）的重度创伤性脑损伤（TBI）患者术前和术后的计算机断层扫描（CT）评分，并比较其预测准确性。
采用单因素和多因素逻辑回归分析来确定损伤后 30 天时 CT 评分（术前和术后）与死亡率之间的关系。通过受试者工作特征曲线（ROC）下面积（AUC）评估术前和术后 CT 评分的判别能力。
多因素逻辑回归分析调整了 TBI 结局的既定预测因素后显示，术前鹿特丹 CT 评分（比值比 [OR]，3.60；95%置信区间 [CI]，1.13-11.50；P=0.030）、术后鹿特丹 CT 评分（OR，4.17；95%CI，1.63-10.66；P=0.003）、术前斯德哥尔摩 CT 评分（OR，3.41；95%CI，1.42-8.18；P=0.006）、术后斯德哥尔摩 CT 评分（OR，4.50；95%CI，1.60-12.64；P=0.004）、术前赫尔辛基 CT 评分（OR，1.44；95%CI，1.03-2.02；P=0.031）和术后赫尔辛基 CT 评分（OR，2.55；95%CI，1.32-4.95；P=0.005）与死亡率显著相关。术后鹿特丹 CT 评分的性能优于术前鹿特丹 CT 评分（AUC，0.82-0.97 与 0.71-0.91）。术后斯德哥尔摩 CT 评分优于术前斯德哥尔摩 CT 评分（AUC，0.76-0.94 与 0.72-0.92）。术后赫尔辛基 CT 评分优于术前赫尔辛基 CT 评分（AUC，0.88-0.99 与 0.65-0.87）。
总之，评估 DC 前后的 CT 评分可能更精确、更高效，可用于预测行 DC 的重度 TBI 患者的早期死亡率。
