Frequency and Impact of Intensive Care Unit Complications on Moderate-Severe Traumatic Brain Injury – Early Results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study
Authors
Muehlschlegel, SusanneCarandang, Raphael A.
Ouillette, Cynthia
Hall, Wiley R.
Anderson, Frederick
Goldberg, Robert J.
Document Type
Poster AbstractPublication Date
2013-05-08Keywords
Critical CareHealth Services Research
Nervous System Diseases
Neurology
Surgery
Translational Medical Research
Trauma
Metadata
Show full item recordAbstract
Background: Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes is poorly understood. Methods: In 213 consecutive msTBI patients admitted to a Level-I-Trauma-Center neuro-trauma-ICU, twenty-eight ICU-COMPL (21 medical and 7 neurological) were prospectively collected and adjudicated by group consensus, using pre-defined criteria. We determined frequencies, and explored associations of ICU-COMPL and functional neurological outcomes measured by Glasgow Outcome Scale (GOS) at hospital discharge using multivariable logistic regression. Results: The average age of the study sample was 53 years, and the median presenting Glasgow Coma Scale and Injury Severity Scores were 5 and 27, respectively. Hyperglycemia (79%), fever (62%), systemic inflammatory response syndrome (60%), and hypotension requiring vasopressors (42%) were the four most common medical ICU-COMPL. Herniation (39%), intracranial rebleed (39%), and brain edema requiring osmotherapy (37%) were the three most common neurological ICU-COMPL. After adjusting for admission variables, duration of ventilation, and ICU length-of-stay, patients with brain edema (OR 5.8; 95% CI 2,16.7) had a significantly increased odds for dying during hospitalization whereas patients with hospital-acquired urinary tract infection (UTI) had a decreased odds (OR 0.05; 95% CI 0.005,0.6). Sensitivity-analysis revealed that UTI occurred later, suggesting a non-causal association with survival. Brain herniation (OR 15.7; 95% CI 2.6,95.4) was associated with an unfavorable functional status (GOS 1-3). Conclusion: ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high-risk patients. Survival associations of time-dependent complications warrant cautious interpretation.DOI
10.13028/478w-4h16Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27803Rights
Copyright the Author(s)Distribution License
http://creativecommons.org/licenses/by-nc-sa/3.0/ae974a485f413a2113503eed53cd6c53
10.13028/478w-4h16