Doty Samuel, Petitt Jordan C, Kashkoush Ahmed, Whiting Benjamin B, Xiao Tianqi, Francis John J, Gunzler Douglas, Roach Mary Joan, Kelly Michael L
Departments of1Neurological Surgery.
2Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; and.
J Neurosurg. 2024 Sep 6;142(2):561-568. doi: 10.3171/2024.5.JNS232842. Print 2025 Feb 1.
The aim of this study was to stratify poly-traumatic brain injury (poly-TBI) patterns into discrete classes and to determine the association of these classes with mortality and withdrawal of life-sustaining treatment (WLST).
The authors performed a single-center retrospective review of their institutional trauma registry from 2018 to 2020 to identify patients with traumatic brain injury (TBI). Patients were included if they had moderate to severe TBI, defined as Glasgow Coma Scale score ≤ 12 and Abbreviated Injury Scale (AIS) head score ≥ 3, and the presence of more than one TBI subtype. TBI subtypes were defined as subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and epidural hemorrhage (EDH). Latent class analysis was used to identify patient classes based on TBI subtypes and Rotterdam CT (RCT) scores. The authors then evaluated class membership in relation to categorical outcomes of in-hospital mortality and WLST by using Lanza et al.'s method.
A total of 125 patients met inclusion criteria for poly-TBI. Latent class analysis yielded 3 poly-TBI classes: class 1-mixed; class 2-SDH/SAH; and class 3-EDH/SAH. Class 1-mixed had a higher likelihood of SDH, SAH, and ICH, and a lower likelihood of EDH. Class 2-SDH/SAH had a higher likelihood of only SDH and SAH. Class 3-EDH/SAH had a higher likelihood of EDH and SAH, and a lower likelihood of SDH and ICH. Class 1-mixed was relatively more likely to have an RCT score of 2. Class 2-SDH/SAH was relatively more likely to have an RCT score of 2, 3, and 4. Class 3-EDH/SAH had a higher likelihood of an RCT score of 3, 4, and 5. Class 1-mixed had significantly lower mortality (χ2 = 7.968; p = 0.005) and less WLST (χ2 = 4.618; p = 0.032) than Class 2-SDH/SAH. Class 2-SDH/SAH had the highest probability of death (0.612), followed by class 3-EDH/SAH (0.385) and class 1-mixed (0.277). Similarly, class 2-SDH/SAH had the highest WLST probability (0.498), followed by class 3-EDH/SAH (0.615) and class 1-mixed (0.238).
Distinct poly-TBI classes were associated with increased in-hospital mortality and WLST. Further research with larger datasets will allow for more comprehensive poly-TBI class definitions and outcomes analysis.
本研究旨在将多发性创伤性脑损伤（poly-TBI）模式分层为不同类别，并确定这些类别与死亡率及生命维持治疗撤除（WLST）之间的关联。
作者对其机构2018年至2020年的创伤登记数据进行了单中心回顾性分析，以识别创伤性脑损伤（TBI）患者。纳入标准为中度至重度TBI，即格拉斯哥昏迷量表评分≤12且简明损伤量表（AIS）头部评分≥3，且存在不止一种TBI亚型。TBI亚型定义为硬膜下出血（SDH）、蛛网膜下腔出血（SAH）、脑内出血（ICH）和硬膜外出血（EDH）。采用潜在类别分析，根据TBI亚型和鹿特丹CT（RCT）评分确定患者类别。然后作者使用兰扎等人的方法评估类别归属与院内死亡率和WLST分类结局之间的关系。
共有125例患者符合poly-TBI纳入标准。潜在类别分析产生了3种poly-TBI类别：1类-混合型；2类-SDH/SAH型；3类-EDH/SAH型。1类-混合型发生SDH、SAH和ICH的可能性较高，发生EDH的可能性较低。2类-SDH/SAH型仅发生SDH和SAH的可能性较高。3类-EDH/SAH型发生EDH和SAH的可能性较高，发生SDH和ICH的可能性较低。1类-混合型相对更可能RCT评分为2分。2类-SDH/SAH型相对更可能RCT评分为2分、3分和4分。3类-EDH/SAH型RCT评分为3分、4分和5分的可能性较高。1类-混合型的死亡率（χ2 = 7.968；p = 0.005）和WLST发生率（χ2 = 4.618；p = 0.032）显著低于2类-SDH/SAH型。2类-SDH/SAH型死亡概率最高（0.612），其次是3类-EDH/SAH型（0.385）和1类-混合型（0.277）。同样，2类-SDH/SAH型WLST概率最高（0.498），其次是3类-EDH/SAH型（0.615）和1类-混合型（0.238）。
不同的poly-TBI类别与院内死亡率增加和WLST相关。使用更大数据集的进一步研究将有助于更全面地定义poly-TBI类别并进行结局分析。
