急性中、重型颅脑损伤早期病死率的预测:Marshall CT分级和Rotterdam CT评分的比较

目的探讨Marshall CT分级和Rotterdam CT评分对急性中、重型颅脑损伤(TBI)早期病死率的预测作用。方法回顾性分析2014~2015年手术治疗的169例急性中、重型TBI的临床资料,伤后24 h内入院并行CT检查,计算Marshall CT分级和Rotterdam CT评分。以伤后14 d观察周期,判断早期死亡。结果 149例中,早期死亡20例,早期病死率为13.4%。与存活病人相比,早期死亡病人入院时GCS评分、运动评分更低(P0.05),瞳孔变化发生率明显增高(P0.05),Marshall和Rotterdam评分更高(P0.05)。随着Marshall分级或Rotterdam评分增高,病死率也随之明显升高(P0.05)。Marshall分级和Rotterdam评分对TBI早期病死率的预测都具有很好的辨别能力,但是Rotterdam评分受试者工作特征曲线下面积(AUC)=0.852;95%CI:0.764~0.941]优于Marshall分级AUC=0.800;95%CI:0.719~0.881]。结论 Marshall CT分级和Rotterdam CT评分都可以很好地预测急性中、重型TBI的早期病死率;由于Rotterdam CT评分包含蛛网膜下腔出血等,或许更适用于弥漫性轴索损伤。

Prediction of early death in patients with traumatic brain injury:a comparison between Marshall and Rotterdam CT scoring systems

Objective To verify the predictive effect of the Rotterdam CT scoring system on early mortality in the patients with traumatic brain injury (TBI). Methods The clinical data of 149 patients with moderate and severe TBI (GCS 3~12 points) were analyzed retrospectively, including following up data and so on 2 weeks after TBI. The abilities of Marshall and Rotterdam scoring systems to predict the early death in the patients with TBI were assessed by the areas under the receiver operating characteristic curve (AUC). Results The total death rate was 13.4% (20/149) 2 weeks after TBI. The early death rate was positively related to the scores less than 5 points of Marshall CT scoring system and the scores of the Rotterdam CT scoring system in the patients with TBI. The present results showed that the AUC of Marshall and Rotterdam CT scoring systems were 0.800 and 0.852 respectively in the patients with TBI. Conclusions The early death rate in the patients with moderate and severe TBI can be predicted by Marshall and Rotterdam scoring systems. Rotterdam scoring system is more proper for the prediction of the early death rate in patients with diffuse axonal injury because it includes the subarachnoid hemorrhage besides other variables included by Marshall CT scoring system.