BIG评分对接受去骨瓣减压术的中重度创伤性脑损伤儿童早期脑功能的预测价值

Predictive Value of BIG Score for Early Brain Function in Children with Moderate-to-Severe Traumatic Brain Injury Who Underwent Decompressive Craniectomy

目的:探讨BIG评分(由格拉斯哥评分、国际标准化比值、碱剩余组成)对接受去骨瓣减压术(DC)的中重度创伤性脑损伤(TBI)患儿脑功能早期预后的预测价值。方法:回顾性分析2014年3月至2023年7月于我院接受DC治疗的所有中重度TBI患儿,以出院时儿童脑功能分类(PCPC)为结局,分为预后良好组(PCPC 1~2)和预后不良组(PCPC 3~6)。通过病历资料回顾,提取患儿的临床信息,并使用Logistic回归分析评估BIG评分的预测价值。结果:共纳入55例接受DC治疗的中重度TBI患儿,其中25例出院时脑功能良好,30例预后不良(包括9例死亡)。患儿入院时的高BIG评分(p < 0.001)、瞳孔对光反射差(p = 0.027),存在失血性休克(p = 0.042)及多发伤(p = 0.043)、脑水肿(p = 0.007),高血糖(p = 0.042)、高乳酸血症(p = 0.029)均与出院时脑功能不良相关。Logistic回归分析显示,入院时的高BIG评分是出院时脑功能不良的独立危险因素。ROC曲线分析确定的最佳BIG评分阈值为17.5,以此预测不良预后的敏感性为66.7%,特异性为88.0%。结论:接受DC的中重度TBI患儿出院时的总体脑功能不良比例为54.5%。入院时的BIG评分能够预测这些患儿出院时的早期脑功能预后,具有较高的敏感性和特异性。

Objective: To explore the predictive value of BIG score (composed of Glasgow coma score, international normalized ratio, and base excess) on the early prognosis of brain function in children with moderate-to-severe traumatic brain injury (TBI) who underwent decompressive craniectomy (DC). Methods: A Retrospective cohort study was conducted in all children with moderate-to-severe TBI who received DC in our hospital from March 2014 to July 2023. Pediatric Cerebral Performance Category (PCPC) at discharge was used as the outcome, according to which children were divided into groups of good prognosis (PCPC 1~2) and poor prognosis (PCPC 3~6). Through data review of medical record, the clinical information of the children was extracted, and logistic regression analysis was used to evaluate the predictive value of BIG score. Results: A total of 55 children with moderate-to-severe TBI who received DC were included, of whom 25 had good brain function at discharge and 30 had poor prognosis (including 9 deaths). The high BIG scores (p < 0.001), poor pupillary light reflex (p = 0.027), hemorrhagic shock (p = 0.042), multiple trauma (p = 0.043), cerebral edema (p = 0.007), hyperglycemia (p = 0.042) and hyperlactatemia (p = 0.029) on admission are associated with poor brain function at discharge. Logistic regression analysis shows that high BIG score on admission is an independent risk factor for poor brain function at discharge. The optimal BIG score threshold determined by ROC curve analysis was 17.5, with a sensitivity of 66.7% and a specificity of 88.0% for predicting poor prognosis. Conclusion: Children with moderate-to-severe TBI who received DC had an overall rate of poor brain function at discharge of 54.5%. The BIG score on admission can predict the early brain function prognosis of these children at discharge, with high sensitivity and specificity.