ABSTRACT
Objective:
To investigate the
risk factors and their
early warning effectiveness for the occurrence of early neurological deterioration (END) in
patients with moderate
traumatic brain injury (modTBI).
Methods:
A retrospective
cohort study was conducted to analyze the clinical data of 265
patients with modTBI admitted to the Second Affiliated
Hospital of Fuyang Normal
University from January 2018 to April 2023. There were 165
males and 100
females, with age range of 20-91 years [(59.5±14.4)years]. The
patients were divided into END group ( n=46) (17.4%) and non-END group ( n=219) (82.6%) according to whether the Glasgow
Coma Score (GCS) decreased by 2 points or more within 72 hours after
injury. Data of the two groups were recorded, including
gender, age, basic
diseases (
hypertension and diabetes), cause of
injury (
traffic injuries,
falls, etc),
vomiting before admission, admission GCS, first CT scan
time,
epilepsy,
brain contusion,
subarachnoid hemorrhage, types of intracranial
hematoma (epidural, subdural, and intracerebral
hematoma), types of fracture (
skull base fracture and
skull fracture),
laboratory indicators [
platelet count (PLT),
blood potassium level,
serum total
calcium concentration,
thrombin time (TT),
prothrombin time (PT),
international normalized ratio (
INR),
activated partial thromboplastin time (APTT), level of
fibrinogen (FIB), and level of D-dimer. Correlations between above-mentioned
indicators and occurrence of END among modTBI
patients were assessed and the independent
risk factors were revealed by univariate and multivariate binary
Logistic regression analysis.
Receiver operating characteristic (ROC) curve and
area under curve (
AUC) were used to evaluate the early-
warning effectiveness of each
risk factor for END.
Results:
Univariate
analysis showed that admission GCS, first CT scan
time, epidural
hematoma, subdural hematoma, intracerebral
hematoma,
serum potassium level, FIB and D-dimer were statistically correlated with occurrence of END among modTBI
patients ( P<0.05 or 0.01). Multivariate binary
Logistic regression analysis showed that admission GCS≤10 points ( OR=0.53, 95% CI 0.34, 0.84, P<0.01), first CT scan
time≤2.0 hours ( OR=0.58, 95% CI 0.37, 0.92, P<0.05), epidural
hematoma ( OR=0.26, 95% CI 0.10, 0.69, P<0.05), intracerebral
hematoma ( OR=0.14, 95% CI 0.04, 0.44, P<0.01), level of FIB≤2.3 g/L ( OR=0.34, 95% CI 0.18, 0.64, P<0.01), level of D-dimer>10.4 mg/L ( OR=1.04, 95% CI 1.02, 1.07, P<0.01) were independent
risk factors for END among modTBI
patients.
ROC curve analysis showed that the first CT scan
time had relatively higher
early warning value (
AUC=0.79, 95% CI 0.74, 0.84), level of D-dimer (
AUC=0.75, 95% CI 0.70, 0.80) and level of FIB (
AUC=0.70, 95% CI 0.65, 0.76) had moderate
early warning value, which was higher than that of admission GCS (
AUC=0.62, 95% CI 0.56, 0.68), intracerebral
hematoma (
AUC=0.62, 95% CI 0.56, 0.68) and epidural
hematoma (
AUC=0.60, 95% CI 0.54, 0.66). The combination of the
risk factors revealed superior
early warning efficiency for END (
AUC=0.90, 95% CI 0.85, 0.93).
Conclusions:
Admission GCS≤10 points, first CT scan
time≤2.0 hours, epidural
hematoma, intracerebral
hematoma, level of FIB≤2.3 g/L and level of D-dimer>10.4 mg/L are independent
risk factors for END among modTBI
patients. The
early warning value of the first CT scan is the highest, followed by D-dimer and FIB, and the
early warning effectiveness of admission GCS, intracerebral
hematoma and epidural
hematoma is ordinary.The combination of the above
risk factors has better
early warning efficiency for occurrence of END among modTBI
patients.
