Abstract:

Objective

To investigate influencing factors of early deterioration in patients with mild traumatic brain injury （mTBI）.

Methods

Clinical data of 264 mTBI patients admitted to Department of Neurosurgery， Linquan County People's Hospital from January 2021 to August 2024 were retrospectively analyzed. The mTBI patients were divided into the deterioration group （26 cases） and the non- deterioration group （238 cases） deponding on whether the patients suffered from deterioration of the condition within 3 d after injury. Independent influencing factors of early deterioration in mTBI patients were revealed by univariate and multivariate Logistic regression analysis. Logistic regression prediction model was constructed based on the above independent influencing factors. Receiver operating characteristic （ROC） curve and area under curve （AUC） were used to evaluate the ability of different influencing factors to predict early deterioration. Internal validation of the prediction model was used by bootstrap analysis.

Results

Among 264 mTBI patients， 26 cases showed deterioration within 3 d after injury （the deterioration group）， and the incidence of deterioration was 9.8%， the remaining 238 patients were in the non-deterioration group. There was statistically significant difference in recurrent vomiting，first CT scan time， GCS score on admission， skull fracture， neutrophil-to-lymphocyte ratio （NLR）， level of fibrinogen （FIB）， and level of D-dimer between the two groups （P＜0.05）. Multivariate Logistic regression analysis showed that recurrent vomiting， first CT scan time， GCS score on admission， NLR， D-dimer were independent influencing factors for early deterioration. ROC curves showed that areas under the curve（AUC） of those independent influencing factors were 0.677， 0.803 （2.2 h as the threshold for first CT scan time）， 0.764 （14 scores as the threshold for GCS score on admission）， 0.753 （6.9 as the threshold for NLR），0.812 （8.6 mg/L as the threshold for D-dimer）. The AUC of the influencing factors combined to predict early deterioration was 0.928 （95%CI： 0.890-0.956， P＜0.001）.

Conclusion

Recurrent vomiting， first CT scan time， GCS score on admission， NLR and D-dimer are independent influencing factors for early deterioration in mTBI patients. These indexes could be jointly used to improve the predictive value for early deterioration.

Key words: Mild traumatic brain injury, Early deterioration, Influencing factors, Prediction