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dc.contributor.authorMuehlschlegel, Susanne
dc.contributor.authorCarandang, Raphael A.
dc.contributor.authorOuillette, Cynthia
dc.contributor.authorHall, Wiley R.
dc.contributor.authorAnderson, Frederick
dc.contributor.authorGoldberg, Robert J.
dc.date2022-08-11T08:08:13.000
dc.date.accessioned2022-08-23T15:46:39Z
dc.date.available2022-08-23T15:46:39Z
dc.date.issued2013-05-08
dc.date.submitted2013-07-17
dc.identifier.doi10.13028/478w-4h16
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27803
dc.description.abstractBackground: 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.
dc.formatyoutube
dc.language.isoen_US
dc.rightsCopyright the Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/
dc.subjectCritical Care
dc.subjectHealth Services Research
dc.subjectNervous System Diseases
dc.subjectNeurology
dc.subjectSurgery
dc.subjectTranslational Medical Research
dc.subjectTrauma
dc.titleFrequency 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
dc.typePoster Abstract
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1157&context=cts_retreat&unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cts_retreat/2013/posters/24
dc.identifier.contextkey4322381
refterms.dateFOA2022-08-23T15:46:40Z
html.description.abstract<p>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.</p> <p>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.</p> <p>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).</p> <p>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.</p>
dc.identifier.submissionpathcts_retreat/2013/posters/24


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