特集：頭部外傷データバンク【プロジェクト2015】（原著）
積極的治療と非積極的治療の比較検討：頭部外傷データバンク プロジェクト2015
2019 年 42 巻 2 号 p. 136-142
詳細
2019 年 42 巻 2 号 p. 136-142
Background: In Japan, the number of geriatric traumatic brain injury (TBI) cases is increasing because of aging in the Japanese population. Decision–making in the treatment of elderly patients involves various aspects. This study aimed to determine the strong predictors for non–aggressive (non–A) treatment at initial visit in cases of severe TBI.
Method: This is a multicenter, prospective observational study. Of the 1,345 cases registered in the Japan Neurotrauma Data Bank (JNTDB) Project 2015, we analyzed the cases of 1,034 patients (mean age, 58 ± 25 years), and excluded cases with missing laboratory data. A decision tree was developed to identify the combination of factors with the highest statistical power to predict the decision–making. The following eight factors were selected: age, body temperature, respiratory rate, oxygen saturation, Glasgow coma scale score, pupil findings, patency of the basal cisterns on head computed tomography (CT) scan, and D–dimer levels. Logistic regression analyses were performed to identify the factors associated with the decision for non–A treatment.
Results: Of the 1,034 patients, aggressive (A) treatment was selected in 887 patients (85.8%), and non–A treatment in 147 patients (14.2%). The decision for non–A treatment was strongly related to three factors: age at the time of injury (A; 57±25 years, non–A; 69±21 years), pupil dilatation (A; n=152 [17%], non–A; n=72 [49%]), and absence of basal cisterns on head CT scan (A; n=181 [20%], non–A; n=75 [51%]) (P<0.01). The cut–off value of patients’ age relative to the univariate analysis was 76 years. The receiver operating characteristic curve value of this factor was 0.83.
Conclusions: Among the cases registered in JNTDB2015, patient’s age was the strong predicting factor for decision–making for non–A treatment. This finding strongly reflects the characteristics of an aging society.
