儿童颅脑损伤出院时BIG评分与功能转归

中国小儿急救医学 Pub Date : 2020-01-20 DOI:10.3760/CMA.J.ISSN.1673-4912.2020.01.103

方伯梁, 钱素云

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摘要

Objective: To explore the relationship between BIG scores (basic defect, INR, GCS) and discharge dysfunction (pediatric brain function classification (PCPC) ≥ 4) in children with multiple traumas complicated with brain injury. Design a retrospective cohort study of pediatric trauma databases from 2001 to 2018. The first level trauma project of the Affiliated Pediatric Hospital of the Place University targets children aged 2-17 who have suffered major blunt trauma, including traumatic brain injury (TBI), and meet the trauma group activation criteria. The intervention measures had no measurement method and the main outcome was determined by two investigators who were previously unaware of the BIG score to determine the discharge PCPC score. Measure the BIG score upon arrival at the emergency department. The age of 609 study patients was (9.7 ± 4.4) years old, with a median injury severity score of 22 (IQR 12). 171/609 cases (28%) had PCPC ≥ 4 (primary outcome). After adjusting for neurosurgical surgical requirements (OR 2.83, 95% CI 1.69-4.74), pupil fixation and dilation (OR 3.1, 95% CI 1.49-6.38), on-site or referral hospital intubation (OR 2.82, 95% CI 1.35-5.87), and other assumed predictive factors for poor prognosis, BIG constituted a multivariate predictor of PCPC ≥ 4 (OR 2.39, 95% CI 1.81-3.15). The area under the BIG ROC curve is 0.87 (0.84-0.90). Using the optimal BIG inflection point value ≤ 8, the sensitivity and net present value of dysfunction at discharge were 93% and 96%, respectively. The sensitivity of GCS ≤ 8 is 79%, and the net present value is 91%. The BIG score of children with GCS score 3 is associated with brain death (OR 2.13, 95% CI 1.58-2.36). BIG also predicted the recovery tendency of hospitalized children (OR 2.26, 95% CI 2.17-2.35). Conclusion: The BIG score is a simple and quickly obtainable disease severity score, which is an independent predictor of functional dependence in TBI and other traumatic children upon discharge. The BIG score may help determine the ideal target audience for TBI trials during the treatment window period in trauma and neurointensive care programs.

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The BIG score and functional outcome at hospital discharge in children with traumatic brain injury

目的探讨多发创伤患儿中合并脑外伤者入急诊科BIG评分(基础缺陷，INR，GCS)与出院时功能障碍[儿科脑功能表现分类(PCPC)≥4]之间的关系。设计 2001至2018年儿科创伤数据库回顾性队列研究。场所大学附属儿科医院一级创伤项目对象 2～17岁儿童遭受包括创伤性脑损伤(TBI)在内的重大钝性创伤，并符合创伤小组激活标准。干预措施无测量方法与主要结果由两名事先不知BIG分值的调查人员确定出院PCPC得分。到达急诊科时测量BIG分值。609例研究患儿年龄(9.7±4.4)岁，中位损伤严重程度评分为22(IQR 12)。171/609例(28%)PCPC≥4(初级结局)。校正神经外科手术需求(OR 2.83，95%CI 1.69-4.74)，瞳孔固定和扩张(OR 3.1，95%CI 1.49-6.38)，现场或转诊医院插管(OR 2.82，95%CI 1.35-5.87)和其他预后不良假定预测因子后，BIG构成了PCPC≥4的多变量预测因子(OR 2.39，95%CI 1.81-3.15)。BIG ROC曲线下面积为0.87(0.84-0.90)。使用最佳BIG拐点值≤8，出院时功能障碍的敏感度和净现值分别为93%和96%。GCS≤8的敏感度为79%，净现值为91%。GCS 3分患儿BIG评分与脑死亡相关(OR 2.13，95%CI 1.58-2.36)。BIG还预测住院患儿康复倾向(OR 2.26，95%CI 2.17-2.35)。结论 BIG评分是一项简单且可快速获得的疾病严重程度评分，为TBI等创伤患儿出院时功能依赖的独立预测因子。BIG得分可能有助于创伤和神经重症监护项目在治疗窗口期确定TBI试验的理想入组对象。

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中国小儿急救医学

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6226

期刊介绍： Chinese Journal of Neurology was established in 1955, the predecessor of which is Chinese Journal of Neurology and Psychiatry. Chinese Journal of Neurology and Psychiatry has been indexed by MEDLINE until 1996, when it was divided into two journals, Chinese Journal of Neurology, and Chinese Journal of Psychiatry. Chinese Journal of Neurology is now indexed by EM, SCOPUS, AJ, WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 2.755 in 2017, ranking the first among all neurological and psychological journals in China and among all the 142 medical journals published by the Chinese Medical Association. The journal is available both in print and online.

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