Isaac Chartelin Jean, Benhamed Axel, Boucher Valérie, Lauzon Samuel, Blanchard Pierre-Gilles, Malo Christian, Bernard Francis, Chauny Jean-Marc, Bérubé Mélanie, Mercier Eric, Gossiome Amaury, D'Astous Myreille, Émond Marcel
Axe santé des populations et pratiques optimales en santé, CHU de Québec-Université Laval Research Center, Québec, QC, Canada.
Faculté de Médecine, Université Laval, Québec, QC, Canada.
CJEM. 2025 Jun 2. doi: 10.1007/s43678-025-00941-2.
Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.
DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.
Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).
In-hospital mortality, complications and prolonged length of stay.
Multivariable logistic regression.
We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.
This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.
据报道，与年轻患者相比，中度创伤性脑损伤（TBI）的老年患者死亡率更高。旨在确定中度TBI患者院内死亡、并发症及住院时间延长的相关危险因素。
设计：一项使用魁北克创伤登记处的多中心观察性队列研究。
年龄≥16岁的中度TBI住院患者（头部损伤，简明损伤量表（AIS）≥3，格拉斯哥昏迷量表（GCS）评分为9 - 12）。
院内死亡率、并发症及住院时间延长。
多变量逻辑回归。
我们纳入了1005例患者，其中38.1%的患者年龄≥65岁。院内死亡率为20.1%。男性（比值比（OR）=1.6 [95%置信区间（CI）：1.02 - 2.6]）、年龄（≥85岁与<65岁相比）（OR = 18.7 [95% CI：9.2 - 38.1]）、≥2种合并症（OR = 2.3 [95% CI：1.3 - 4.0]）、损伤严重程度评分（OR = 1.04 [95% CI：1.01 - 1.1]）、脑实质内血肿的存在（OR = 3.5 [95% CI：2.2 - 5.5]）或其他CT扫描结果（脑水肿、气颅、软脑膜下出血和垂体损伤）（OR = 1.9 [95% CI：1.2 - 3.1]）与死亡几率增加相关。男性（OR = 1.8 [95% CI：1.2 - 2.6]）、年龄（65 - 74岁：OR = 1.7 [95% CI：1.1 - 2.8] & 75 - 84岁：OR = 1.6 [95% CI：1.03 - 2.6]）、≥2种合并症（OR = 2.9 [95% CI：1.8 - 4.7]）、胸腹联合伤（OR = 2.0 [95% CI：1.01 - 3.8]）和蛛网膜下腔出血（OR = 7.6 [95% CI：1.5 - 38.5]）与并发症几率增加相关。合并症数量（≥2 OR = 1.7 [95% CI：1.1 - 2.7]）、脊柱损伤（OR = 2.4 [95% CI：1.4 - 4.1]）和谵妄（OR = 3.1 [95% CI：1.8 - 5.2]）与住院时间延长几率增加相关。
本研究确定了院内死亡、并发症及住院时间延长的危险因素，其中大多数在急诊科（ED）可快速获得。这些因素可帮助临床医生识别院内死亡风险高的中度TBI患者，并指导关于治疗目标的共同决策。
