既往创伤性脑损伤是中重度创伤性脑损伤患者院内死亡的一个危险因素：一项TRACK-TBI队列研究。
Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study.
作者信息
Yue John K, Etemad Leila L, Elguindy Mahmoud M, van Essen Thomas A, Belton Patrick J, Nelson Lindsay D, McCrea Michael A, Vreeburg Rick J G, Gotthardt Christine J, Tracey Joye X, Coskun Bukre C, Krishnan Nishanth, Halabi Cathra, Eagle Shawn R, Korley Frederick K, Robertson Claudia S, Duhaime Ann-Christine, Satris Gabriela G, Tarapore Phiroz E, Huang Michael C, Madhok Debbie Y, Giacino Joseph T, Mukherjee Pratik, Yuh Esther L, Valadka Alex B, Puccio Ava M, Okonkwo David O, Sun Xiaoying, Jain Sonia, Manley Geoffrey T, DiGiorgio Anthony M, Badjatia Neeraj, Barber Jason, Bodien Yelena G, Fabian Brian, Ferguson Adam R, Foreman Brandon, Gardner Raquel C, Gopinath Shankar, Grandhi Ramesh, Russell Huie J, Dirk Keene C, Lingsma Hester F, MacDonald Christine L, Markowitz Amy J, Merchant Randall, Ngwenya Laura B, Rodgers Richard B, Schneider Andrea L C, Schnyer David M, Taylor Sabrina R, Temkin Nancy R, Torres-Espin Abel, Vassar Mary J, Wang Kevin K W, Wong Justin C, Zafonte Ross D
机构信息
Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands.
出版信息
Trauma Surg Acute Care Open. 2024 Jul 24;9(1):e001501. doi: 10.1136/tsaco-2024-001501. eCollection 2024.
OBJECTIVES
An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort.
METHODS
Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury.
RESULTS
Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months.
CONCLUSIONS
After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed.
LEVEL OF EVIDENCE
IV.
TRIAL REGISTRATION NUMBER
NCT02119182.
目的
据估计，14%-23%的创伤性脑损伤（TBI）患者一生中会发生多次TBI。中度至重度TBI（msTBI）患者既往TBI与预后之间的关系尚未明确。我们在美国一个前瞻性msTBI队列中研究了既往TBI、住院死亡率以及伤后12个月内的预后之间的关联。
方法
从创伤性脑损伤转化研究与临床知识研究（入组时间：2014-2019年）中提取格拉斯哥昏迷量表评分为3-12分的住院受试者的数据。使用俄亥俄州立大学TBI识别方法评估伴有失忆或意识改变的既往TBI。针对年龄、性别、精神病史、颅脑损伤和颅外损伤严重程度进行竞争风险回归分析，以研究既往TBI与住院死亡率之间的关联，将出院存活作为竞争风险。报告调整后的风险比（aHR（95%CI））。多变量逻辑回归分析评估了既往TBI、死亡率以及伤后3、6和12个月时不良预后（格拉斯哥扩展预后量表评分1-3分（对比4-8分））之间的关联。
结果
在405例急性msTBI受试者中，21.5%有既往TBI，这与男性（87.4%对77.0%，p=0.037）和精神病史（34.5%对20.7%，p=0.010）相关。住院死亡率为10.1%（既往有TBI：17.2%，无既往TBI：8.2%，p=0.025）。竞争风险回归分析表明，既往TBI与住院死亡可能性相关（aHR=2.06（1.01-4.22）），但与出院存活无关。既往TBI与伤后3、6和12个月时的死亡率或不良预后无关。
结论
急性msTBI后，既往TBI病史与住院死亡率独立相关，但与伤后12个月内的死亡率或不良预后无关。这种选择性关联强调了在急性住院后早期收集标准化既往TBI病史数据以进行风险分层的重要性。需要进行前瞻性验证研究。
证据级别
IV级。
试验注册号
NCT02119182。
Zotero 插件