Imanishi Yuya, Ohtake Makoto, Akimoto Taisuke, Kawasaki Takafumi, Yasuda Masaki, Shizawa Kaoru, Suenaga Jun, Kawasaki Takashi, Sakata Katsumi, Takeuchi Ichiro, Yamamoto Tetsuya
Department of Neurosurgery Yokohama City University Graduate School of Medicine Yokohama Japan.
Department of Emergency and Critical Care Yokohama City University Medical Center Yokohama Japan.
Acute Med Surg. 2025 Apr 25;12(1):e70058. doi: 10.1002/ams2.70058. eCollection 2025 Jan-Dec.
To evaluate the prognostic factors in severe head trauma patients (Glasgow Coma Score (GCS) ≤ 8) with all trauma, including those with trunk injury as well as single severe head trauma (abbreviated injury scale (AIS) ≥ 3).
We included 152 consecutive patients with head trauma (AIS ≥ 3) and consciousness disorders (GCS ≤ 8) who were transported to our institute from January 2017 to October 2022. Data on the patients' background, vital signs at presentation, multiple trauma (AIS ≥ 3 in two or more locations), surgical intervention, and hematological findings were examined; a retrospective analysis was conducted with the modified Rankin Scale score after 3 months assigned as the primary outcome.
The patients' mean age was 57.6 ± 23.4 years (0-89), 49 patients (32.2%) had multiple trauma, and 25 patients (16.4%) had accompanying shock vital signs. In the multivariate analysis of prognosis, age ( = 0.0007) and D-dimer levels ( = 0.0007) were independent poor prognostic factors. On the contrary, patients with multiple trauma ( = 0.027) and shock vital signs at presentation ( = 0.037) had a significantly better prognosis. In the non-shock group, 97.6% (41/42) of patients aged ≥50 years and with D-dimer level of 40 μg/mL or higher had a poor prognosis after 3 months.
Advanced age and high D-dimer levels are important independent associated factors in patients with severe consciousness disorder associated with head trauma; meanwhile, the prognosis is more favorable in patients whose consciousness disorders are associated with multiple trauma or circulatory failure, indicating that rapid improvement of circulatory failure may lead to better outcomes.
评估所有创伤（包括伴有躯干损伤以及单纯性重度颅脑创伤（简明损伤定级标准（AIS）≥3））的重度颅脑创伤患者（格拉斯哥昏迷评分（GCS）≤8）的预后因素。
我们纳入了2017年1月至2022年10月间连续收治的152例颅脑创伤（AIS≥3）且有意识障碍（GCS≤8）并被转运至我院的患者。对患者的背景资料、入院时的生命体征、多发伤（两个或更多部位AIS≥3）、手术干预及血液学检查结果进行了研究；以3个月后的改良Rankin量表评分作为主要结局指标进行回顾性分析。
患者的平均年龄为57.6±23.4岁（0 - 89岁），49例患者（32.2%）有多发伤，25例患者（16.4%）伴有休克生命体征。在预后的多因素分析中，年龄（P = 0.0007）和D - 二聚体水平（P = 0.0007）是独立的不良预后因素。相反地，有多发伤的患者（P = 0.027）及入院时伴有休克生命体征的患者（P = 0.037）预后明显更好。在非休克组中，年龄≥50岁且D - 二聚体水平≥40μg/mL的患者中97.6%（41/42）在3个月后预后不良。
高龄和高D - 二聚体水平是重度颅脑创伤伴严重意识障碍患者重要的独立相关因素；同时，意识障碍与多发伤或循环衰竭相关的患者预后更有利，这表明循环衰竭的快速改善可能带来更好的结局。
