Lee Se Won, Werner Bryan, Anireddy Saswatha, Ayutyanont Napatkamon
From the Sunrise Health GME Consortium, MountainView Hospital, HCA Healthcare, Las Vegas, Nevada.
Am J Phys Med Rehabil. 2024 Jan 1;103(1):47-52. doi: 10.1097/PHM.0000000000002298. Epub 2023 Aug 7.
The aim of the study is to investigate the characteristics and hospital outcomes of patients with mild traumatic brain injuries.
A total of 1940 patients with mild traumatic brain injuries from seven community hospitals between 2017 and 2019 were identified using International Classification of Disease codes and an documented initial Glasgow Coma Scale score of 13-15. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge.
The median age was 69 yrs old with 66.6% associated with falls at admission. Subdural hemorrhage was the most common brain lesion and more common in the group with falls. Increased age, male sex, epidural hemorrhage, presence of hemiplegia, paraplegia, renal disease, cancer, hospital-acquired sepsis, anemia, and use of direct vasodilator were associated with increased odds of in-hospital mortality. Increased age, medical coverage by Medicare, cerebral edema, lower initial Glasgow Coma Scale, length of stay, comorbidity of acute myocardiac infarction, and use of thiamine and opioids were associated with decreased likelihood of discharge to home.
Recognizing characteristics of hospitalized patients with mild traumatic brain injuries and their association with increased in-hospital mortality and nonhome discharge can be useful for improving care of this vulnerable population.
本研究旨在调查轻度创伤性脑损伤患者的特征及住院结局。
利用国际疾病分类编码，在2017年至2019年间从7家社区医院识别出1940例轻度创伤性脑损伤患者，且记录的初始格拉斯哥昏迷量表评分为13 - 15分。采用逐步逻辑回归分析来确定与住院死亡率和出院回家相关的人口统计学和临床特征。
中位年龄为69岁，66.6%的患者入院时与跌倒相关。硬膜下出血是最常见的脑损伤，在跌倒组中更常见。年龄增加、男性、硬膜外出血、偏瘫、截瘫、肾病、癌症、医院获得性脓毒症、贫血以及使用直接血管扩张剂与住院死亡率增加的几率相关。年龄增加、医疗保险覆盖、脑水肿、初始格拉斯哥昏迷量表评分较低、住院时间、急性心肌梗死合并症以及硫胺素和阿片类药物的使用与出院回家的可能性降低相关。
认识到轻度创伤性脑损伤住院患者的特征及其与住院死亡率增加和非回家出院的关联，可能有助于改善对这一弱势群体的护理。
