Analysis of influencing factors of prognosis of severe traumatic brain injury with severe multiple injuries under multi⁃disciplinary team

Abstract

Objective To explore and analyze the influencing factors of multi⁃disciplinary team (MDT) model in treatment of severe traumatic brain injury (sTBI) with severe multiple injuries, and to summarize the diagnosis and treatment experience. Methods Total 144 patients of sTBI with severe multiple injuries treated in a MDT model at The Affiliated Hospital of Guizhou Medical University from January 2016 to June 2021 were included. Glasgow Outcome Scale (GOS) was used to assess prognosis at discharge, univariate and multivariate stepwise Logistic regression analyses were used to screen for influencing factors postoperative prognosis. Results A total of 144 patients were divided into good prognosis group (n = 101) and poor prognosis group (n = 43) according to the GOS score at discharge. The poor prognosis group included hypertension (P = 0.003), diabetes (P = 0.004), smoking (P = 0.000), drinking (P = 0.000), traumatic shock (P = 0.009) and brain hernia formation (P = 0.000), combined chest injury (P = 0.046), abdominal injury (P = 0.000) and spinal injury (P = 0.009), the proportion of concurrent pulmonary infections (P = 0.031), multiple organ dysfunction syndrome (MODS, P = 0.004), ventilator ⁃ assisted ventilation (P = 0.005), and tracheostomy (P = 0.005) during treatment were higher than those in good prognosis group, while the proportion of Glasgow Coma Scale (GCS) score (P = 0.000) and brain contusion and laceration (P = 0.013) at admission were lower than those in good prognosis group. Logistic regression analysis showed diabetes (OR = 4.119, 95%CI: 2.632-5.832; P = 0.042), abdominal injury (OR = 1.183, 95%CI: 1.000-1.269; P = 0.006), low GCS score at admission (OR = 4.949, 95%CI: 1.609-15.218; P = 0.005), and MODS during treatment (OR = 4.642, 95%CI: 4.068-5.216; P = 0.008) were risk factors for poor prognosis of patients of sTBI with severe multiple injuries, while tracheotomy was a protective factor for good prognosis (OR = 0.223, 95%CI: 0.062-0.384; P = 0.007). Conclusions sTBI with severe multiple injuries is complicated and difficult to treat. Diabetes, combined with abdominal injury, low GCS score at admission, and MODS during treatment are risk factors for poor prognosis of patients of sTBI with severe multiple injuries under MDT.

DOI: 10.3969/j.issn.1672⁃6731.2023.10.005