背景:创伤性脑损伤(TBI)是全球范围内死亡和残疾的主要原因,严重病例会显著增加并发症和长期死亡率的风险。老年创伤结果评分(GTOS),根据年龄,损伤严重程度,和输血的需要,已被验证用于预测老年创伤患者的死亡率,但其在预测TBI患者死亡率方面的效用仍有待探索。
方法:这项回顾性研究包括5543例成年创伤患者,这些患者患有孤立的中度至重度TBI,由1998年至2021年的头部缩短损伤量表(AIS)评分≥3定义。GTOS用以下公式计算:年龄+(损伤严重度评分×2.5)+22(如果在24小时内输血)。受试者工作特征曲线下面积(AUROC)评估了GTOS预测死亡率的能力。最佳GTOS截止值是使用Youden指数确定的。比较了高和低GTOS组的死亡率,由最佳GTOS截止值分隔,包括调整基线特征的倾向评分匹配分析。
结果:在5543名患者中,死亡率为8.3%(462例死亡).较高的死亡率与男性有关,年龄较大,更高的GTOS,和高血压等合并症,冠状动脉疾病,和终末期肾病.预测死亡率的最佳GTOS临界值为121.5(AUC=0.813)。即使研究人群与倾向评分相匹配,GTOS≥121.5的患者死亡几率更高(比值比2.64,95%置信区间1.93-3.61,p<0.001),住院时间更长(平均16.7vs.12.2天,p<0.001)比GTOS<121.5的那些。
结论:这些研究结果支持GTOS是对孤立的中度至重度TBI患者进行院内死亡率风险分层的有用工具。然而,我们鼓励进一步研究完善GTOS,以便更好地应用于TBI患者.
BACKGROUND: Traumatic brain injury (TBI) is a major cause of mortality and disability worldwide, with severe cases significantly increasing the risk of complications and long-term mortality. The Geriatric Trauma Outcome Score (GTOS), based on age, injury severity, and transfusion need, has been validated for predicting mortality in older trauma patients, but its utility in predicting mortality for TBI patients remains unexplored.
METHODS: This retrospective study included 5543 adult trauma patients with isolated moderate to severe TBI, defined by head Abbreviated Injury Scale (AIS) scores of ≥ 3, from 1998 to 2021. GTOS was calculated with the following formula: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) assessed GTOS\'s ability to predict mortality. The optimal GTOS cutoff value was determined using Youden\'s index. Mortality rates were compared between high- and low-GTOS groups, separated by the optimal GTOS cutoff value, including a propensity score-matched analysis adjusting for baseline characteristics.
RESULTS: Among 5543 patients, mortality was 8.3% (462 deaths). Higher mortality is correlated with male sex, older age, higher GTOS, and comorbidities like hypertension, coronary artery disease, and end-stage renal disease. The optimal GTOS cut-off for mortality prediction was 121.5 (AUC = 0.813). Even when the study population was matched by propensity score, patients with GTOS ≥121.5 had much higher odds of death (odds ratio 2.64, 95% confidence interval 1.93-3.61, p < 0.001) and longer hospital stays (mean 16.7 vs. 12.2 days, p < 0.001) than those with GTOS < 121.5.
CONCLUSIONS: These findings support the idea that GTOS is a useful tool for risk stratification of in-hospital mortality in isolated moderate to severe TBI patients. However, we encourage further research to refine GTOS for better applicability in TBI patients.