ORIGINAL
Introdução: A incidência de TCE vem aumentando, levando a déficits neurocognitivos e na saúde mental. Logo, o prognóstico desses pacientes tornou-se importante e avaliar a eficácia dos métodos é necessária. Objetivo: Determinar a acurácia das escalas tomográficas em vítimas de TCE no Brasil. Métodos: A partir de um banco de dados digital, foram coletados dados clínico-epidemiológicos, laboratoriais e radiológicos de 517 doentes admitidos em uma UTI especializada em trauma, no período de março de 2012 a janeiro de 2015. Para determinação do desempenho do modelo foi feito a discriminação pela análise da área sob as curvas ROC (AUC). Resultados: A média de idade foi de 41,4+-18 anos, sendo 440 (85,1%) do sexo masculino. A mortalidade em 14 dias foi de 22,8% e a mortalidade hospitalar de 30,9%. A classificação tomográfica de Marshall (ROC=0,61 e 0,58) para predizer mortalidade em 14 dias e hospitalar não apresentou relevância estatística. Os escores de Rotterdam (ROC=0,76 e 0,73) de Helsinki (ROC=0,74 e 0,72), apresentaram maior poder discriminatório para predizer mortalidade sem diferença estatisticamente significativa entre eles (p>0,05). O poder discriminatório das escalas diminuiu para eventos mais tardios. Conclusão: A escala de Marshall infere muito mais um diagnóstico do que uma ferramenta prognóstica. Para este fim, sugerimos a utilização das escalas de Rotterdam ou de Helsinki, pelo maior poder discriminatório apresentado.
Introduction: The incidence of TBI has been increasing leading to neurocognitive and mental health deficits. Therefore, the prognosis of these patients has become important and evaluation of the effectiveness of the methods is necessary. Objective: To determine the accuracy of tomographic scales in TBI victims in Brazil. Methods: From a digital database, clinical-epidemiological, laboratory and radiological data were collected from 517 patients admitted to a specialized trauma ICU, from Mar 2012 to Jan 2015. To determine the performance of the model, discrimination was performed by analyzing the area under the ROC curves (AUC). Results: The mean age was 41.4+-18 years, and 440 (85.1%) were male. The 14-day mortality was 22.8% and the in-hospital mortality was 30.9%. Marshall’s tomographic classification (ROC=0.61 and 0.58) to predict 14-day and in-hospital mortality was not statistically relevant. Rotterdam scores (ROC=0.76 and 0.73) and Helsinki scores (ROC=0.74 and 0.72) showed greater discriminatory power to predict mortality; with no statistically significant difference between them (p>0.05). The discriminatory power of the scales decreased for later events. Conclusion: The Marshall scale infers much more a diagnosis than a prognostic tool. For this purpose, we suggest using the Rotterdam or Helsinki scales, due to their greater discriminatory power.
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1MD, MR, Medical Residency in General Surgery, General Surgery Service, Getúlio Vargas University Hospital - HUGV-Ufam, Manaus, AM, Brazil.
2MS, medical student, Medicine Course, Federal University of Amazonas - Ufam, Manaus, AM, Brazil.
3MD, PhD, Neurosurgeon, Neurosurgery Service, Post-Graduation Program in Health Sciences, Getúlio Vargas University Hospital - HUGV-Ufam, Manaus, AM, Brazil.
Received Jan 10, 2023
Accepted May 22, 2023
