Single center clinical analysis of “zero-channel” for severe traumatic brain injury

doi:10.3877/cma.j.issn.2095-9141.2025.01.004

Abstract

Abstract:

Objective

To explore the role of “zero-channel” treatment in improving the prognosis of patients with severe traumatic brain injury （sTBI）.

Methods

Seventy-three patients with sTBI admitted to Neurotrauma Intensive Care Department of Zhujiang Hospital of Southern Medical University from March 2018 to March 2020 through the “green channel” were retrospectively collected and set as the green channel group； 54 patients with sTBI through the “zero-channel” from March 2020 to March 2023 were set as the zero-channel group. The general information，injury severity at admission，channel service time，and prognosis were compared between two groups. Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for the prognosis of patients treated via the “zerochannel”.

Results

The time from admission to examination and from examination to surgery in the zerochannel group for sTBI was shorter than that in the green channel group，and the surgery rate within the“golden hour” and good prognosis rate were higher than that in the green channel group，and differences were statistically significant （P＜0.05）. In the zero-channel group，there were 10 cases with good prognosis and 44 cases with poor prognosis. There were statistically significant differences in age，the time from admission to examination and from examination to surgery between the good prognosis group and the poor prognosis group （P＜0.05）. Multivariate Logistic regression analysis showed that age ≥55 years and the time from admission to examination ≥10 min were independent risk factors for poor prognosis in the zerochannel group patients.

Conclusion

Compared to the “green channel”，the “zero-channel” can significantly shorten service time and improve patient prognosis，while age ≥55 years and hospital examination time ≥10 min are independent risk factors for poor prognosis in “zero-channel” patients.

Key words: Severe traumatic brain injury, Zero-channel, Green channel, Prognosis

Chunyu Tan, Zhangyi Wu, Shengfan Zhang, Hui Du, Qinghua Wang, Jun Wang. Single center clinical analysis of “zero-channel” for severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(01): 26-31.

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Figures/Tables 6

Tab.1 Comparison of general information between two groups of sTBI patients

组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	基础疾病史			致伤因素
组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	高血压	糖尿病	冠心病	交通伤	坠落伤	其他
零通道组	54	38/16	51.50±15.55	11	6	5	16	24	14
绿色通道组	73	46/27	50.51±15.10	16	10	6	20	23	30
χ ²/t 值		0.750	0.535	0.044	0.189	0.042	0.076	2.229	3.155
P值		0.386	0.593	0.833	0.664	0.837	0.783	0.135	0.076

Tab.1 Comparison of general information between two groups of sTBI patients

组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	基础疾病史			致伤因素
组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	高血压	糖尿病	冠心病	交通伤	坠落伤	其他
零通道组	54	38/16	51.50±15.55	11	6	5	16	24	14
绿色通道组	73	46/27	50.51±15.10	16	10	6	20	23	30
χ ²/t 值		0.750	0.535	0.044	0.189	0.042	0.076	2.229	3.155
P值		0.386	0.593	0.833	0.664	0.837	0.783	0.135	0.076

Tab.2 Comparison of injuries between two groups of sTBI patients upon admission

组别	例数	GCS评分						Marshall CT分级
组别	例数	3分	4分	5分	6分	7分	8分	Ⅲ级	Ⅳ级	Ⅵ级
零通道组	54	6	4	16	4	10	14	16	10	28
绿色通道组	73	9	5	22	5	3	19	23	14	36
Z值				-0.563					-0.283
P值				0.573					0.777

Tab.3 Comparison of channel service time between two groups of sTBI patients

组别	例数	发病-到院时间［min，M（Q1，Q3）］	到院-检查时间［min，M（Q1，Q3）］	检查-手术时间［min，M（Q1，Q3）］	“黄金1 h”［例（%）］
零通道组	54	207.50（71.75，410.00）	10.00（4.00，11.00）	45.00（38.00，51.00）	44（81.48）
绿色通道组	73	207.00（71.50，413.00）	21.00（14.00，29.50）	49.00（44.00，54.00）	23（9.59）
Z/χ ²值		-0.093	-8.974	-2.156	31.102
P值		0.926	＜0.001	0.031	＜0.001

Tab.4 Comparison of GOS scores between two groups of sTBI patients

组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	预后良好［例（%）］
零通道组	54	8	24	12	4	6	10（18.52）
绿色通道组	73	12	36	20	0	5	5（6.85）
Z/χ ²值				-0.981			4.058
P值				0.327			0.044

Tab.5 Comparison of general data between patients with good prognosis and poor prognosis in the zero-channel group

项目	预后良好组（n=10）	预后不良组（n=44）	Z/χ ²值	P值
性别			0.126	0.722
男	8	30
女	2	14
年龄			4.641	0.031
＜55岁	8	16
≥55岁	2	28
GCS评分			2.209	0.137
＜5分	4	6
≥5分	6	38
Marshall CT分级			-1.810	0.070
Ⅲ级	4	12
Ⅳ级	4	6
Ⅵ级	2	26
发病-到院时间			0.045	0.832
＜1 h	2	5
≥1 h	8	39
到院-检查时间			6.682	0.010
＜10 min	8	12
≥10 min	2	29
检查-手术时间			5.146	0.023
＜40 min	6	9
≥40 min	4	38

Tab.6 Multivariate Logistic regression analysis of poor prognosis affecting patients in the zero-channel group

因素	偏回归系数	标准误	Waldχ ²值	OR 值	95%CI	P值
年龄
＜55岁				Ref（ 1）
≥55岁	2.074	0.978	4.498	7.956	1.170～54.076	0.034
到院-检查时间
＜10 min				Ref（ 1）
≥10 min	2.463	0.993	6.148	11.738	1.675～82.242	0.013
检查-手术时间
＜40 min				Ref（ 1）
≥40 min	1.670	0.918	3.308	5.313	0.879～32.130	0.069

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