Chao Min, Wang Chia-Cheng, Chen Carl P C, Chung Chia-Ying, Ouyang Chun-Hsiang, Chen Chih-Chi
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan.
Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan.
J Pers Med. 2022 Jun 30;12(7):1075. doi: 10.3390/jpm12071075.
(1) Background: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Serious extracranial injury (SEI) commonly coexists with sTBI after the high impact of trauma. Limited studies evaluate the influence of SEI on the prognosis of pediatric sTBI. We aimed to analyze SEI's clinical characteristics and initial presentations and evaluate if SEI is predictive of higher in-hospital mortality in these sTBI children. (2) Methods: In this 11-year-observational cohort study, a total of 148 severe sTBI children were enrolled. We collected patients' initial data in the emergency department, including gender, age, mechanism of injury, coexisting SEI, motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and intracranial Rotterdam computed tomography (CT) score of the first brain CT scan, as potential mortality predictors. (3) Results: Compared to sTBI children without SEI, children with SEI were older and more presented with initial hypotension and hypothermia; the initial lab showed more prolonged prothrombin time and a higher in-hospital mortality rate. Multivariate analysis showed that motor components of mGCS, fixed pupil reaction, prolonged prothrombin time, and higher Rotterdam CT score were independent predictors of in-hospital mortality in sTBI children. SEI was not an independent predictor of mortality. (4) Conclusions: sTBI children with SEI had significantly higher in-hospital mortality than those without. SEI was not an independent predictor of mortality in our study. Brain injury intensity and its presentations, including lower mGCS, fixed pupil reaction, higher Rotterdam CT score, and severe injury-induced systemic response, presented as initial prolonged prothrombin time, were independent predictors of in-hospital mortality in these sTBI children.
(1) 背景：重型颅脑损伤（sTBI）是儿童死亡的主要原因。在遭受高强度创伤后，严重的颅外损伤（SEI）常与sTBI同时存在。有限的研究评估了SEI对小儿sTBI预后的影响。我们旨在分析SEI的临床特征和初始表现，并评估SEI是否可预测这些sTBI儿童的院内死亡率更高。(2) 方法：在这项为期11年的观察性队列研究中，共纳入了148例重型sTBI儿童。我们收集了患者在急诊科的初始数据，包括性别、年龄、损伤机制、并存的SEI、格拉斯哥昏迷量表运动部分（mGCS）评分、体温、血压、血糖水平、初始凝血酶原时间以及首次脑部CT扫描的颅内鹿特丹CT评分，作为潜在的死亡率预测指标。(3) 结果：与无SEI的sTBI儿童相比，有SEI的儿童年龄更大，更多出现初始低血压和体温过低；初始实验室检查显示凝血酶原时间更长，院内死亡率更高。多因素分析显示，mGCS运动部分、固定瞳孔反应、凝血酶原时间延长以及较高的鹿特丹CT评分是sTBI儿童院内死亡率的独立预测因素。SEI不是死亡率的独立预测因素。(4) 结论：有SEI的sTBI儿童的院内死亡率显著高于无SEI的儿童。在我们的研究中，SEI不是死亡率的独立预测因素。脑损伤强度及其表现，包括较低的mGCS、固定瞳孔反应、较高的鹿特丹CT评分以及严重损伤引起的全身反应，表现为初始凝血酶原时间延长，是这些sTBI儿童院内死亡率的独立预测因素。
