Analysis Of Clinical Characteristics And Prognostic Risk Factors In Patients With Moderate To Severe Traumatic Brain Injury

Objective: To analyze the clinical characteristics of patients with moderate to severe TBI,including vital signs,Glasgow coma scale and hematological indexes,to explore the correlation between them and the death events of patients with moderate to severe TBI and its value in evaluating the prognosis of patients with moderate to severe TBI.Methods: The clinical data of moderate to severe TBI patients admitted to the emergency room of General Hospital of Eastern Theater Command from January,2017 to January,2020 were collected.The patients with moderate to severe TBI were divided into survival group and death group based on the death of 28 days,and the clinical characteristics of the two groups were analyzed.The differences in clinical characteristics of patients between the two groups were compared,and risk factors related to the death of patients with moderate to severe TBI were analyzed.The patients with moderate to severe TBI were divided into moderate group(9≤GCS≤12)and severe group(3≤GCS≤8)according to the GCS score,and the risk factors for death of patients with moderate to severe TBI were analyzed and compared between the two groups.Analyze and compare the evaluation value of independent risk factors for death in patients with moderate to severe TBI,and establish a prognostic prediction model.Results: This study finally included 249 moderate to severe TBI patients,including176(70.6%)males and 73(29.4%)females.The GCS score of the survival group was significantly higher than that of the death group,and the levels of D-dimer and CK-MB were significantly lower than those of the death group.The difference was statistically significant(p<0.05).At the same time,the results of multivariate logistic regression analysis showed that GCS score(OR=0.626,95%CI:0.532-0.736,p<0.01),D-dimer(OR=1.048,95%CI:1.019-1.078,p<0.01)and CK-MB(OR=1.008,95%CI:1.003-1.013,p<0.01)were independent risk factors for death in patients with moderate to severe TBI.The area under the ROC curve generated by the GCS score,D-dimer,CK-MB,and the three combined model are 0.828(95%CI:0.775-0.873),0.684(95%CI: 0.622-0.741),0.758(95%CI: 0.700-0.810),0.870(95%CI: 0.821-0.909),respectively;the three combined model predicts that the area under the ROC curve for the prognosis of patients with moderate to severe TBI is greater than GCS score,D-dimer and CK-MB alone predicted area(p<0.05).Conclusion: The GCS score,D-dimer and CK-MB levels at admission are independent risk factors related to the prognosis of patients with moderate to severe TBI.The combined model of the three is better than single factor in predicting death events in patients with moderate to severe TBI.It is expected to be used to judge the condition and evaluate the prognosis of patients with moderate to severe TBI.