Choi S C, Barnes T Y, Bullock R, Germanson T A, Marmarou A, Young H F
Department of Biostatistics, Medical College of Virginia/Virginia Commonwealth University, Richmond.
J Neurosurg. 1994 Aug;81(2):169-73. doi: 10.3171/jns.1994.81.2.0169.
The authors present data describing the temporal progress of 786 severely head-injured patients from discharge to 12 months postinjury. Changes in outcome over time are characterized and the effects on these changes of patient age, Glasgow Coma Scale score, pupillary response, and type of injury are investigated. The feasibility of using these factors and the outcome at 3 months postinjury to predict the outcome at 6 months post-trauma is explored via logistic regression analysis. The data indicate that a significant proportion of patients improve continuously during the first 6 months after injury; outcome tends to stabilize thereafter, which suggests that the response at this time may be the appropriate end point for clinical trials in severe head injury. Dichotomized outcomes are predictable with approximately 94% accuracy at 6 months postinjury; therefore, missing outcomes may safely be replaced by the corresponding predicted outcomes. The findings also indicate striking improvement over time in patients who are in a vegetative state at discharge, suggesting that decisions regarding withdrawal of supportive care should be postponed until 6 months after injury in these patients.
作者展示了描述786例重度颅脑损伤患者从出院到伤后12个月的时间进展的数据。对随时间推移的结果变化进行了特征描述，并研究了患者年龄、格拉斯哥昏迷量表评分、瞳孔反应和损伤类型对这些变化的影响。通过逻辑回归分析探讨了使用这些因素以及伤后3个月的结果来预测创伤后6个月结果的可行性。数据表明，相当一部分患者在受伤后的前6个月内持续改善；此后结果趋于稳定，这表明此时的反应可能是重度颅脑损伤临床试验的合适终点。在伤后6个月，二分法结果的预测准确率约为94%；因此，缺失的结果可以安全地用相应的预测结果替代。研究结果还表明，出院时处于植物人状态的患者随时间推移有显著改善，这表明对于这些患者，关于停止支持治疗的决定应推迟到受伤后6个月。
