Siegel J H
Department of Surgery, New Jersey Trauma Center, New Jersey Medical School: UMD, Newark, USA.
J Neurotrauma. 1995 Aug;12(4):579-90. doi: 10.1089/neu.1995.12.579.
Studies of 4590 patients with blunt trauma injuries admitted to a Level I Trauma Center, have shown that 37% had a blunt traumatic brain injury (BTBI). Of these brain injured patients 60% has an associated other injury. Examination of mortality has shown that those with an isolated brain injury had an 11% mortality compared with 21.8% in those with an associated systemic injury. Further investigation demonstrated that the cause of the increased mortality was related to the blood loss associated with the injuries and that when hypovolemic shock resulted, mortality rose from 12.8 to 62%. The severity of the associated injuries effect on the brain injured patient could be estimated by a parameter of oxygen debt, the base deficit and this allowed for a quantitative estimate of the probability of death as an index of severity. A combined linear logistic model using the admission Glasgow Coma Score (GCS) as a measure of brain injury and the base deficit as a measure of physiologic injury provides such a predictive score. The effect of associated injuries in patients with moderate brain injury (AIS 2,3) was to increase the average total cost of medical care in the first year of injury by three-fold ($12,489 to $36,177) and for severe brain injury (AIS 4,5) to increase average cost from $59,000 in isolated BTBI to $90,000 in BTBI with associated injury. The high incidence of brain injuries in motor vehicle crashes (MVC) caused by lateral impacts and their association with other side-impact injuries (lungs, spleen, kidney, and pelvic fractures) in which large blood volume losses are common, focuses attention on the need for side impact protection standards that simultaneously protect brain, thoracoabdominal viscera, and pelvis as a means of reducing the severity and cost of lateral impact MVCs.
对一家一级创伤中心收治的4590例钝性创伤患者的研究表明，37%的患者患有钝性创伤性脑损伤（BTBI）。在这些脑损伤患者中，60%还伴有其他损伤。死亡率调查显示，单纯脑损伤患者的死亡率为11%，而伴有全身损伤的患者死亡率为21.8%。进一步调查表明，死亡率增加的原因与损伤相关的失血有关，当发生低血容量性休克时，死亡率从12.8%升至62%。可以通过氧债参数碱缺失来估计相关损伤对脑损伤患者的影响程度，这使得能够对死亡概率进行定量估计，作为严重程度的指标。使用入院时格拉斯哥昏迷评分（GCS）作为脑损伤的衡量指标，碱缺失作为生理损伤的衡量指标的联合线性逻辑模型提供了这样一个预测评分。中度脑损伤（AIS 2,3）患者中相关损伤的影响是使受伤后第一年的医疗总费用平均增加两倍（从12489美元增至36177美元），对于重度脑损伤（AIS 4,5）患者，单纯BTBI的平均费用为59000美元，伴有相关损伤的BTBI平均费用增至90000美元。侧面撞击导致的机动车碰撞（MVC）中脑损伤的高发生率，以及它们与其他侧面撞击损伤（肺、脾、肾和骨盆骨折）的关联，其中大量失血很常见，这使得人们将注意力集中在需要制定侧面撞击保护标准上，该标准能同时保护脑、胸腹内脏和骨盆，以此作为降低侧面撞击MVC严重程度和成本的一种手段。
