基于电子病历首页的颅脑创伤出院时结局影响因素:附4058例分析  

Analysis of influencing factors of traumatic brain injury outcome at discharge based on electronic health record home pages:4058 cases

作　　者：蒋丽丹[1] 杨俊[2] 张洪兵[2] 王宁[1] JIANG Li-dan;YANG Jun;ZHANG Hong-bing;WANG Ning(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]首都医科大学附属北京潞河医院神经外科,101149

出　　处：《中国现代神经疾病杂志》2022年第7期608-614,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：2021年度北京市重大疫情防治重点专科项目。

摘　　要：目的 总结北京市通州区颅脑创伤随社会经济快速发展的变化特点,以为调整疾病的预防策略和高危人群的治疗策略提供依据。方法 计算机自动提取首都医科大学附属北京潞河医院电子病历系统中2004年12月1日至2018年10月22日记录的颅脑创伤患者的病历首页,回顾分析其临床特点,单因素和多因素前进法Logistic回归分析筛查出院时病死相关危险因素。结果 共筛选出4058例颅脑创伤患者,出院时生存3683例(90.76%),病死375例(9.24%)。不同年龄(χ^(2)=51.526,P=0.000)、不同致伤原因(χ^(2)=82.349,P=0.000)、不同治疗方法(χ^(2)=186.270,P=0.000)、不同住院时间(χ^(2)=9.842,P=0.000)出院时病死率差异具有统计学意义,其中,45~64、65~74和≥75岁患者病死率高于15~24和25~44岁(均P <0.01),≥75岁患者病死率亦高于45~64岁(P=0.001);交通事故伤病死率高于摔伤(P=0.000),交通事故伤、摔伤、其他致伤原因病死率高于暴力打击伤(均P=0.000);接受神经外科手术和非神经外科手术患者病死率高于保守治疗(均P=0.000);住院时间1~14 d患者病死率高于15~30 d和>30 d(均P=0.000)。Logistic回归分析显示,45~64岁(OR=2.285,95%CI:1.428~3.657;P=0.001)、65~74岁(OR=4.025,95%CI:2.334~6.941;P=0.000)、≥75岁(OR=5.757,95%CI:3.317~9.991;P=0.000),2007-2010年入院(OR=1.856,95%CI:1.376~2.504;P=0.000),接受神经外科手术(OR=6.465,95%CI:4.991~8.376;P=0.000)和非神经外科手术(OR=3.389,95%CI:1.828~6.283;P=0.000),住院时间1~14 d(OR=6.023,95%CI:3.822~9.490;P=0.000)是颅脑创伤患者出院时病死的危险因素,而暴力打击伤是出院时病死的保护因素(OR=0.245,95%CI:0.112~0.537;P=0.000)。结论 颅脑创伤病死率仍较高,45岁以上、2007-2010年入院、交通事故伤、接受神经外科手术和非神经外科手术、住院时间1~14 d的患者出院时病死率较高。ObjectiveTo summarize the characteristics and changes of traumatic brain injury(TBI)in Tongzhou district of Beijing with the rapid development of social economy,in order to provide thetheoretical basis for adjustment of the prevention and treatment strategies in high risk population.MethodsThe home pages of electronic health record(EHR) of patients with TBI from December 1,2004 to October 22,2018 were automatically extracted from the EHR of Beijing Luhe Hospital,Capital MedicalUniversity.The clinical characteristics were retrospectively analyzed,and the risk factors related to deathat discharge were screened by univariate and multivariate forward Logistic regression analysis.ResultsAtotal of 4058 patients with TBI were screened out,of which 3683 cases(90.76%) survived and 375 cases(9.24%) died at discharge.The mortality at discharge was significantly different among different age(χ^(2)=51.526,P = 0.000),causes of injury(χ^(2)= 82.349,P = 0.000),treatment modalities(χ^(2)= 186.270,P = 0.000)and hospital length(χ^(2)= 9.842,P = 0.000).The mortality of patients aged 45-64,65-74 and ≥ 75 years washigher than that of patients aged 15-24 and 25-44 years(P 30 d(P = 0.000,for all).Logistic regression analysis showed that 45-64 years old(OR =2.285,95%CI:1.428-3.657;P = 0.001),65-74 years old(OR = 4.025,95%CI:2.334-6.941;P = 0.000),≥75 years old(OR = 5.757,95%CI:3.317-9.991;P = 0.000),hospital admission in year 2007-2010(OR =1.856,95%CI:1.376-2.504;P = 0.000),treatment with neurosurgery(OR = 6.465,95%CI:4.991-8.376;P =0.000) and non-neurosurgical procedures(OR = 3.389,95%CI:1.828 to 6.283;P = 0.000),hospital length 1-14 d(OR = 6.023,95%CI:3.822-9.490;P = 0.000) were risk factors for death at discharge of TBI patients,and violent injury was a protective factor for death at discharge(OR = 0.245,95%CI:0.112-0.537;P =0.000).ConclusionsThe mortality of TBI is still high,patients over 45 years,hospital admission in year2007-2010,traffic accident injury,treatment with neurosurgery and non-neurosurgery,and hospital length

关 键 词：脑损伤 创伤性 医院信息系统 死亡率 危险因素 LOGISTIC模型 

分 类 号：R651.15[医药卫生—外科学]