Purpose:Cerebral edema(CE)is the main secondary injury following traumatic brain injury(TBI)caused by road traffic accidents(RTAs).It is challenging to be predicted timely.In this study,we aimed to develop a predictio...Purpose:Cerebral edema(CE)is the main secondary injury following traumatic brain injury(TBI)caused by road traffic accidents(RTAs).It is challenging to be predicted timely.In this study,we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries.Methods:This case-control study included 218 patients with TBI caused by RTAs.The cohort was divided into CE and non-CE groups,according to CT results within 7 days.Demographic data,imaging data,and clinical data were collected and analyzed.Quantitative variables that follow normal distribution were presented as mean±standard deviation,those that do not follow normal distribution were presented as median(Q1,Q3).Categorical variables were expressed as percentages.The Chi-square test and logistic regression analysis were used to identify risk factors for CE.Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries.The efficacy of the model was evaluated using the receiver operator characteristic curve.Results:According to the study,almost half(47.3%)of the patients were found to have CE.The risk factors associated with CE were bilateral frontal lobe contusion,unilateral frontal lobe contusion,cerebral contusion,subarachnoid hemorrhage,and abbreviated injury scale(AIS).The odds ratio values for these factors were 7.27(95%confidence interval(CI):2.08-25.42,p=0.002),2.85(95%CI:1.11-7.31,p=0.030),2.62(95%CI:1.12-6.13,p=0.027),2.44(95%CI:1.25-4.76,p=0.009),and 1.5(95%CI:1.10-2.04,p=0.009),respectively.We also observed that patients with mild/moderate TBI(AIS≤3)had a 50%probability of developing CE 19.7 h after injury(χ^(2)=13.82,adjusted R2=0.51),while patients with severe TBI(AIS>3)developed CE after 12.5 h(χ^(2)=18.48,adjusted R2=0.54).Finally,we conducted a receiver operator characteristic curve analysis of CE time,which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI,respectively.Conclusion:Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury.Specifically,those with more severe injuries experienced an earlier onset of CE.These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.展开更多
目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段(3、6、9、12月)分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调...目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段(3、6、9、12月)分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调查和对患者进行精神检查及智力量表(Wechsler Intellegence Scale for Adult,WAIS)、社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)和日常生活能力量表(Activity of Daily Living Scale,ADL)测验,据此进行诊断及评残。结果ADL、SDSS对不同等级伤残及不同时间段区分良好,整体样本显示患者ADL、SDSS平均值9月与12月无差别,轻度伤残ADL、SDSS平均值6、9、12月无差别,中度伤残ADL、SDSS平均值9月与12月无差别,重度伤残ADL平均值6、9、12月无差别。结论脑外伤所致精神障碍伤残鉴定轻度伤残以伤后6个月评定为宜,中度伤残以伤后9个月评定为宜,重度伤残统计结论显示评残时机为伤后6个月,但综合分析认为重度伤残以伤后9个月评定为宜。展开更多
基金support from Chongqing Natural Science Foundation Innovation and Development Joint Fund (grant Nos.CSTB2023NSCQ-LZX0155)Chongqingmedicalscientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (grant Nos.2023MSXM009).
文摘Purpose:Cerebral edema(CE)is the main secondary injury following traumatic brain injury(TBI)caused by road traffic accidents(RTAs).It is challenging to be predicted timely.In this study,we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries.Methods:This case-control study included 218 patients with TBI caused by RTAs.The cohort was divided into CE and non-CE groups,according to CT results within 7 days.Demographic data,imaging data,and clinical data were collected and analyzed.Quantitative variables that follow normal distribution were presented as mean±standard deviation,those that do not follow normal distribution were presented as median(Q1,Q3).Categorical variables were expressed as percentages.The Chi-square test and logistic regression analysis were used to identify risk factors for CE.Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries.The efficacy of the model was evaluated using the receiver operator characteristic curve.Results:According to the study,almost half(47.3%)of the patients were found to have CE.The risk factors associated with CE were bilateral frontal lobe contusion,unilateral frontal lobe contusion,cerebral contusion,subarachnoid hemorrhage,and abbreviated injury scale(AIS).The odds ratio values for these factors were 7.27(95%confidence interval(CI):2.08-25.42,p=0.002),2.85(95%CI:1.11-7.31,p=0.030),2.62(95%CI:1.12-6.13,p=0.027),2.44(95%CI:1.25-4.76,p=0.009),and 1.5(95%CI:1.10-2.04,p=0.009),respectively.We also observed that patients with mild/moderate TBI(AIS≤3)had a 50%probability of developing CE 19.7 h after injury(χ^(2)=13.82,adjusted R2=0.51),while patients with severe TBI(AIS>3)developed CE after 12.5 h(χ^(2)=18.48,adjusted R2=0.54).Finally,we conducted a receiver operator characteristic curve analysis of CE time,which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI,respectively.Conclusion:Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury.Specifically,those with more severe injuries experienced an earlier onset of CE.These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.
文摘目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段(3、6、9、12月)分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调查和对患者进行精神检查及智力量表(Wechsler Intellegence Scale for Adult,WAIS)、社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)和日常生活能力量表(Activity of Daily Living Scale,ADL)测验,据此进行诊断及评残。结果ADL、SDSS对不同等级伤残及不同时间段区分良好,整体样本显示患者ADL、SDSS平均值9月与12月无差别,轻度伤残ADL、SDSS平均值6、9、12月无差别,中度伤残ADL、SDSS平均值9月与12月无差别,重度伤残ADL平均值6、9、12月无差别。结论脑外伤所致精神障碍伤残鉴定轻度伤残以伤后6个月评定为宜,中度伤残以伤后9个月评定为宜,重度伤残统计结论显示评残时机为伤后6个月,但综合分析认为重度伤残以伤后9个月评定为宜。
