METHODS: This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed.
RESULTS: A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%.
CONCLUSIONS: The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
方法:本研究在三个一级创伤中心进行。回顾性分析2016年9月至2017年12月期间年龄≥16岁的复杂mTBI患者(格拉斯哥昏迷量表评分13-15)的连续医疗记录。排除穿透性创伤患者和有记录的脑肿瘤或动脉瘤的患者。主要结果是神经外科介入和/或mTBI相关死亡的组合。进行敏感性和特异性分析。
结果:共纳入477例患者,其中8.4%的人接受了神经外科手术,3%的人死于mTBI。40名患者(8%)被分类为uBIG-1,168名(35%)被分类为uBIG-2,269名(56%)被分类为uBIG-3。uBIG-1中没有患者接受神经外科手术或因受伤而死亡。这转化为预测转移需求的敏感性为100%(95%CI93.2%-100%)和特异性为9.4%(95%CI6.8%-12.6%)。使用uBIG可能会将转移次数减少6%至25%。
结论:uBIG-1患者可以在其初始中心安全管理,而无需转移到神经创伤护理水平较高的中心。尽管uBIG可以减少转移的数量,进一步完善标准可以提高其特异性.