To Analyze The Risk Factors On The Prognosis Of Moderate And Severe Traumatic Brain Injury In Children

Objective:To analyze the risk factors that affect the prognosis of moderate and severe traumatic brain injury（TBI）in children,to put forward the early warning indexes which should be paid attention to in clinic,and to provide theoretical and practical data for improving the treatment effect of moderate and severe traumatic brain injury in children.Methods:In this study,it was collected that the relevant data of 118 patients were diagnosed as moderate and severe traumatic brain injury in children by Pediatric intensive care unit（PICU）of the Second Affiliated Hospital of Hebei Medical University from April 2018 to October 2020.According to Glasgow Outcome Scale（GOS）,the patients were divided into two group:good prognosis group（GOS score 3-5）and poor prognosis group（GOS score 1-2）.The general data was compared between the two groups on admission(（gender,age）,time of visit,Glasgow coma score（GCS）,invasive blood pressure（BP）,arterial partial pressure of oxygen（Pa O₂）,blood glucose（Glu）,lactate（Lac）,procalcitonin（PCT）,C-reactive rotein（CRP）,brain edema,epidural hemorrhage,subdural hemorrhage,intracranial hemorrhage,skull base fracture,cerebral hernia and gastrointestinal hemorrhage etc;next,univariate analysis was performed to find significant factors;after that,the multivariate Logistic regression model was used to determine the independent risk factors;in the end,by analyzing the independent risk factors,the receiver operating characteristic curve（ROC curve）was used to assess the diagnostic value of prognosis and the sensitivity and specificity of each index,and determine the best cut-off value（Cut-off value）on the poor prognosis of moderate and severe TBI in children.P<0.05 indicates that the difference is statistically significant.Results:1.Among 118 patients of moderate and severe TBI in children,102 patients were survived,16 patients were died and the fatality rate was13.56%.Among them,78 patients were in good prognosis group and 40patients were in poor prognosis group.2.Univariate analysis showed that there was no statistical difference between the good prognosis group and the poor prognosis group in gender,age,visiting time,epidural hemorrhage,subdural hemorrhage,intracranial hemorrhage at admission and skull base fractures（P>0.05）;there was statistical differences in GCS score,BP,Pa O2,Glu,Lac,PCT,CRP,cerebral edema,cerebral herniation and gastrointestinal hemorrhage between the two groups of children（P<0.05）.3.Multivariate logistic regression results showed:GCS score（OR,0.277,95%CI,0.151-0.508）,Lac（OR,1.559,95%CI,0.254-1.939）,Glu（1.373,95%CI,1.041-1.803）,Gastrointestinal bleeding（OR,3.891,95%CI,1.402-10.401）,cerebral edema（OR,4.454,95%CI,1.312-15.124）,BP（OR,0.045,95%CI,0.016-0.129）,Pa O2（OR,0.364,95%CI,0.135-0.978）and brain herniation（OR,0.134,95%CI,0.034-0.523）are independent risk factors that affect the prognosis of moderate and severe traumatic brain injury in children.4.ROC curve analysis results showed:The area under the curve of GCS score,Lac,Glu,gastrointestinal hemorrhage,cerebral edema,BP,Pa O2 herniation value is 0.922,0.822,0.718,0.647,0.706,0.787,0.647,0.612;the best cut-off values of GCS score,Lac and Glu were 5 points,3.23mmol/L and 8.58mmol/L,respectively;the sensitivity and specificity of GCS score,Lac and Glu were（0.900,0.885）,（0.875,0.833）,（0.600,0.833）,respectively.Conclusion:1.GCS score,lactic acid,blood sugar,invasive blood pressure,arterial partial pressure of oxygen,gastrointestinal hemorrhage,cerebral edema,and cerebral herniation may be associated with the prognosis of moderate and severe traumatic brain injury in children.2.GCS score,lactic acid,blood sugar,invasive blood pressure,arterial partial pressure of oxygen,gastrointestinal hemorrhage,cerebral edema,and cerebral herniation are independent risk factors that affect the prognosis of moderate and severe traumatic brain injury in children.3.GCS score,lactic acid,blood sugar,invasive blood pressure,arterial oxygen pressure,cerebral edema,gastrointestinal hemorrhage,and cerebral herniation all have certain early warning value for the prognosis of moderate and severe traumatic brain injury in children.Among them,GCS score has high warning value,and when the GCS score is below 5,the risk of poor prognosis is significantly increased in moderate and severe traumatic brain injury in children.The lactic acid has medium warning value,and When the lactic acid is above 3.23mmol/L,the risk of poor prognosis is significantly increased in moderate and severe traumatic brain injury in children.Blood sugar has medium warning value,and When the blood sugar is above8.58mmol/L,the risk of poor prognosis is significantly increased in moderate and severe traumatic brain injury in children.The early warning value of invasive blood pressure and cerebral edema are medium,while the early warning value of arterial oxygen partial pressure,gastrointestinal hemorrhage and cerebral hernia is low;therefore,it should be paid attention to in clinical work.