Analysis Of Prognostic Factors In 11,937 Cases Of Patients With Acute Traumatic Brain Injury

Objective: To analyze the factors that may be related to the prognosis of patients with acute brain trauma and severe brain trauma, and establish prognostic models on clinical data by the statistical analysis of the data from Chinese Head Trauma Data Bank.Method: All the data of 11937 cases with acute brain trauma are from Chinese Head Trauma Data Bank, contain gender, age, causes of trauma, admission Glasgow coma scale, first CT(computed tomography) scan characteristics, surgery, second CT scan characteristics(delayed hematoma), second surgery, the temperature, ICP(intracranial pressure), arterial PH, arterial partial pressure of oxygen of the first, second, third, seventh, tenth, fourteenth days after injury and Glasgow outcome scale discharged. Statistical analysis of the data are performed by Chi-squaretest and multiple binary logistic regression analysis with the SPSS19.0 statistical package.Results:(1) 11,937 cases with acute traumatic brain injury patients, include 8768 cases of male(73.5%), 3169 cases of female(26.5%), and theaverage age is 41.89±0.46 years old, the high incidence group is the group of 18-65 years old(76.6%), trauma related to a car accident ranks the first(53.5%), severe trauma group(GCS=3-8 points) includes 2776 cases(23.3%), 2776 cases of severe acute traumatic brain injury patients, include 2121 cases of male(76.4%), 655 cases of female(23.6%), the average age is 43.54±0.87 years old, the high incidence group is the group of 18-65 years old age(82.1%), trauma related to a car accident is still topped(66%).(2)The results of univariate analysis of 11937 cases with acute brain trauma are that age, causes of trauma, GCS, first CT scan characteristics(cerebral contusion, subarachnoid hemorrhage, hernia, epidural hematoma, subdural hematoma, intracerebral hematoma), surgery, second CT scan characteristics(delayed hematoma), the temperature, ICP, arterial PH, arterial partial pressure of oxygen of the first day after injury are significantly related to the mortality and morbidity of patients, gender is related to the morbidity of patients. The results of logistic are that GCS, the temperature of the first day after injury, subdural hematoma, delayed hematoma, age and epidural hematoma are related to the mortality of patients. The prognostic model is:P=1/(1+e-y),Y=-6.700+1.523×GCS- 0.570×the temperature of the first day after injury+0.517 × subdural hematoma+0.513 × delayed hematoma +0.461 ×age-0.376 ×epidural hematoma, AUC(area under curve)of ROC(receiver operating characteristic curve)is 0.847, the best dangerous value is P= 0.027 with a sensitivity of 0.867 and a specificity of 0.652. The GCS, delayed hematoma, age, surgery, epidural hematoma, brain contusion, the temperature of the first day after injury and subdural hematoma are related to the morbidity of patients. The prognostic model is:P=1/(1+e-y),Y=-6.497+1.655×GCS+0.663×delayed hematoma +0.502×age+0.445×surgery-0.428×epidural hematoma +0.279×brain contusion-0.271×the temperature of the first day after injury +0.260×subdural hematoma, AUC=0.878, the best dangerous value is P=0.182 with a sensitivity of 0.809 and a specificity of 0.831.(3) The results of univariate analysis of 2776 cases with severe acute brain trauma are that age, GCS, cerebral contusion, subarachnoid hemorrhage, hernia, epidural hematoma, subdural hematoma, intracerebral hematoma, delayed hematoma, the temperature, ICP, arterial PH, arterial partial pressure of oxygen of the first day after injury are significantly related to the mortality and morbidity of patients, surgery is related to the morbidity of patients. The results of logistic are that GCS, delayed hematoma, epidural hematoma, the temperature of the first day after injury, age and subdural hematoma are related to the mortality of patients. The prognostic model is:P=1/(1+e-y),Y=1.278-0.603×GCS+0.586×delayed hematoma-0.519×epidural hematoma-0.514×the temperature of the first day after injury+0.452×age+0.379×subdural hematoma, AUC=0.791, the best dangerous value is P=0.208 with a sensitivity of 0.752 and a specificity of 0.706. The delayed hematoma, GCS, age, epidural hematoma, brain contusion, the temperature of the first day after injury and intracerebral hematoma are related to the morbidity of patients. The prognostic model is : P=1/(1+e-y), Y = 1.988 +0.842 × delayed hematoma-0.568 ×GCS+0.531 × age-0.450 × epidural hematoma +0.428 × brain contusion-0.247×the temperature of the first day after injury +0.214×intracerebral hematoma, AUC=0.768, the best dangerous value is P=0.439 with a sensitivity of 0.760 and a specificity of 0.653.Conclusions:(1) Adult male group is of high risk of acute brain trauma, and the primary cause of injury is related to car accident, mild head trauma is still the majority of all, but severe traumatic brain injury ranks second now;(2) GCS, the temperature of the first day after injury, subdural hematoma, delayed hematoma, age and epidural hematoma are related to the mortality of patients with acute brain trauma, indicated a poorer outcome; severity, delayed hematomas, age, surgery, epidural hematoma, cerebral contusion, temperature at first day and epidural hematomas are related to morbidity of acute head trauma patients;(3)GCS, delayed hematoma, epidural hematoma, the temperature of the first day after injury, age and subdural hematoma are related to the mortality of patients with severe brain trauma. Delayed hematoma, GCS, age, epidural hematoma, brain contusion, the temperature of the first day after injury and intracerebral hematoma are related to the morbidity of patients,P≧0.439 means a poorer outcome.