Kaewborisutsakul Anukoon, Tunthanathip Thara
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Acute Crit Care. 2022 Aug;37(3):429-437. doi: 10.4266/acc.2021.01795. Epub 2022 Jun 23.
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King's Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0-42.9), Glasgow coma scale scores of 3-8 (OR, 8.2; 95% CI, 1.7-38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6-8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6-7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62-10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003-26.1) were also included.
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.
儿童创伤性脑损伤（TBI）后发生的硬膜下血肿（SDH）可导致意外死亡或残疾。列线图是医生用于为家长提供预后建议以辅助治疗决策的临床预测工具。在本研究中，开发并验证了一种用于预测结局的列线图。此外，还确定了与创伤性SDH患儿结局相关的预测因素。
在这项回顾性研究中，对103例TBI后发生SDH的儿童进行了评估。根据儿童头部损伤国王结局量表分类，在出院时评估功能结局，并分为良好和不良两类。使用二元逻辑回归分析与不良结局相关的预测因素。随后，开发了一个二维列线图来呈现预测模型。
具有最低赤池信息准则水平的预测模型包括低血压（比值比[OR]，9.4；95%置信区间[CI]，2.0 - 42.9）、格拉斯哥昏迷量表评分为3 - 8分（OR，8.2；95% CI，1.7 - 38.9）、单眼瞳孔固定（OR，4.8；95% CI，2.6 - 8.8）和双眼瞳孔固定（OR，3.5；95% CI，1.6 - 7.1）。还包括中线移位≥5 mm（OR，1.1；95% CI，0.62 - 10.73）和并存的脑室内出血（OR，6.5；95% CI，0.003 - 26.1）。
小儿TBI中的SDH可导致死亡和残疾。本研究中列线图的预测水平极佳，应进行外部验证以确认该临床预测工具的性能。
