目的:很少有大型研究调查机动车碰撞(MVCs)后伴随轻度创伤性脑损伤(mTBI)发生的相关因素和结果。因此,这项研究的目的是评估MVC特征是否可以预测哪些mTBI患者会合并鞭打损伤,以及伴随鞭打损伤是否会影响这些患者的护理利用率。
方法:这项回顾性队列研究纳入了从美国外科医生协会创伤质量计划数据集中发现的22,213例mTBI患者,经过MVC检查。建立了分层逻辑回归模型,以调查与伴随鞭打损伤相关的患者和MVC因素。倾向评分匹配鞭打状态,结合多变量逻辑回归模型,评估伴随鞭打是否影响住院几率。在住院患者的亚组中,研究了与住院时间(LOS)和出院处置的相关性.
结果:年龄中位数(IQR)为34(24-51)岁,格拉斯哥昏迷评分中位数为15分(15-15)。伴随鞭打的患者年龄较大(中位数为36岁vs34岁,p=0.03),住院率更高(75%vs64%,p<0.001)。在与伴随鞭打损伤相关的分层模型中,血液酒精含量(BAC)高于联邦驾驶限值的患者发生伴随鞭打的几率较低(OR0.63,95%CI0.49-0.81),气囊展开者(OR0.80,95%CI0.68-0.95),但使用安全带的几率较大(OR1.41,95%CI1.16-1.71).匹配后,伴随鞭打与住院几率增加独立相关(OR1.67,95%CI1.40-1.99),而使用安全带与住院几率降低相关(OR0.88,95%CI0.81-0.95).在住院患者中,伴随鞭打与医院LOS或出院处置无关.
结论:MVC特征如饮酒和安全气囊展开对mTBI患者伴随鞭打的发展具有保护作用,而使用安全带的风险较高。伴随鞭打会增加mTBI患者住院的几率,但不会影响住院LOS或出院处置。而安全带的使用与较低的住院率和更有利的住院过程有关。这些发现为常见的损伤机制后的损伤模式和护理提供提供了背景。
Few large studies have investigated the factors and outcomes related to concomitant injuries occurring alongside mild traumatic brain injury (mTBI) after motor vehicle collisions (MVCs). Thus, the objective of this study was to assess whether MVC characteristics predict which patients with mTBI will have concomitant whiplash injury, and whether concomitant whiplash injury affects care utilization for these patients.
This retrospective cohort study included 22,213 patients with mTBI after MVC identified from the American College of Surgeons Trauma Quality Programs dataset. A hierarchical logistic regression model was constructed to investigate patient and MVC factors associated with concomitant whiplash injury. Propensity score matching on whiplash status, in conjunction with a multivariable logistic regression model, assessed if concomitant whiplash affected odds of hospitalization. In the subgroup of patients who were hospitalized, associations with hospital length of stay (LOS) and discharge disposition were investigated.
The median (IQR) age was 34 (24-51) years, with a median Glasgow Coma Scale score at presentation of 15 (15-15). Patients with concomitant whiplash were older (median 36 years vs 34 years, p = 0.03) and had higher rates of hospitalization (75% vs 64%, p < 0.001). In the hierarchical model for associations with concomitant whiplash injury, patients with blood alcohol content (BAC) greater than the federal driving limit had lower odds of concomitant whiplash (OR 0.63, 95% CI 0.49-0.81) along with those who had
airbag deployment (OR 0.80, 95% CI 0.68-0.95), but seatbelt use was associated with greater odds (OR 1.41, 95% CI 1.16-1.71). After matching, concomitant whiplash was independently associated with increased odds of hospitalization (OR 1.67, 95% CI 1.40-1.99) while seatbelt use was associated with decreased odds (OR 0.88, 95% CI 0.81-0.95). Among hospitalized patients, concomitant whiplash was not associated with hospital LOS or discharge disposition.
MVC characteristics such as alcohol consumption and
airbag deployment were protective toward development of concomitant whiplash for mTBI patients, while seatbelt use was associated with higher risk. Concomitant whiplash increases the odds of hospitalization for mTBI patients but does not affect hospital LOS or discharge disposition, while seatbelt use is associated with lower rates of hospitalization and a more favorable hospital course. These findings provide context to injury patterns and care provision after a common mechanism of injury.