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Abstract：
OBJECTIVE Prediction of death and functional outcome is essential for determining treatment strategies and allocation of resources for patients with severe traumatic brain injury (TBI). The aim of this study was to evaluate, by using pupillary status and Glasgow Coma Scale (GCS) score, if patients with severe TBI who are ≤ 15 years old have a lower mortality rate and better outcome than adults with severe TBI. METHODS A retrospective cohort analysis of patients suffering from severe TBI registered in the Trauma Registry of the German Society for Trauma Surgery between 2002 and 2013 was undertaken. Severe TBI was defined as an Abbreviated Injury Scale of the head (AIShead) score of ≥ 3 and an AIS score for any other part of the body that does not exceed the AIShead score. Only patients with complete data (GCS score, age, and pupil parameters) were included. To assess the impact of GCS score and pupil parameters, the authors also used the recently introduced Eppendorf-Cologne Scale and divided the study population into 2 groups: children (0-15 years old) and adults (16-55 years old). Each patient\'s outcome was measured at discharge from the trauma center by using the Glasgow Outcome Scale. RESULTS A total of 9959 patients fulfilled the study inclusion criteria; 888 (8.9%) patients were ≤ 15 years old (median 10 years). The overall mortality rate and the mortality rate for patients with a GCS of 3 and bilaterally fixed and dilated pupils (19.9% and 16.3%, respectively) were higher for the adults than for the pediatric patients (85% vs 80.9%, respectively), although cardiopulmonary resuscitation rates were significantly higher in the pediatric patients (5.6% vs 8.8%, respectively). In the multivariate logistic regression analysis, no motor response (OR 3.490, 95% CI 2.240-5.435) and fixed pupils (OR 4.197, 95% CI 3.271-5.386) and bilateral dilated pupils (OR 2.848, 95% CI 2.282-3.556) were associated with a higher mortality rate. Patients ≤ 15 years old had a statistically lower mortality rate (OR 0.536, 95% CI 0.421-0.814; p = 0.001). The rate of good functional outcomes (Glasgow Outcome Scale Score 4 or 5) was higher in pediatric patients than in the adults (72.2% vs 63.1%, respectively). CONCLUSIONS This study found that severe TBI in children aged ≤ 15 years is associated with a lower mortality rate and superior functional outcome than in adults. Also, children admitted with a missing motor response or fixed and bilaterally dilated pupils also have a lower mortality rate and higher functional outcome than adults with the same initial presentation. Therefore, patients suffering from severe TBI, especially pediatric patients, could benefit from early and aggressive treatment.
摘要：
目的预测死亡和功能结局对于确定重型颅脑损伤（TBI）患者的治疗策略和资源分配至关重要。这项研究的目的是评估，通过使用瞳孔状态和格拉斯哥昏迷量表（GCS）评分，如果≤15岁的重度TBI患者比重度TBI患者的死亡率更低，预后更好。方法对2002年至2013年德国创伤外科学会创伤登记处注册的严重TBI患者进行回顾性队列分析。严重TBI定义为头部的缩写损伤量表（AIShead）评分≥3，身体任何其他部位的AIS评分不超过AIShead评分。只有数据完整的患者(GCS评分，年龄,和瞳孔参数）包括在内。为了评估GCS评分和瞳孔参数的影响，作者还使用了最近推出的Eppendorf-Cologne量表,并将研究人群分为2组:儿童(0-15岁)和成人(16-55岁).在创伤中心出院时，使用格拉斯哥预后量表测量每位患者的预后。结果：共有9959例患者符合研究纳入标准；888例（8.9%）患者年龄≤15岁（中位数为10岁）。GCS为3且双侧固定和散瞳的患者的总死亡率和死亡率（19.9％和16.3％，分别)成人患者高于儿科患者(85%vs80.9%，分别)，尽管儿科患者的心肺复苏率明显更高（5.6％vs8.8％，分别)。在多变量逻辑回归分析中，无运动反应(OR3.490,95%CI2.240-5.435)、固定瞳孔(OR4.197,95%CI3.271-5.386)和双侧散瞳(OR2.848,95%CI2.282-3.556)与较高死亡率相关。≤15岁患者的死亡率在统计学上较低（OR0.536，95％CI0.421-0.814；p=0.001）。儿科患者的良好功能结局率（格拉斯哥预后量表评分4或5）高于成人（72.2％vs63.1％，分别)。结论本研究发现，年龄≤15岁儿童的严重TBI与成人相比，死亡率较低，功能预后较好。此外，与初始表现相同的成年人相比,因运动反应缺失或瞳孔固定和双侧扩张而入院的儿童的死亡率和功能结局也较低.因此,患有严重TBI的患者，尤其是儿科患者，可以从早期和积极的治疗中受益。
