Research Reports - Impact of non-neurological complications in severe traumatic brain injury outcome

Luisa Corral, Casimiro F Javierre, Josep L Ventura, Pilar Marcos, Jose I Herrero and Rafael Manez

Critical Care 2012, 16:R44

Introduction

Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the Intensive Care Unit (ICU), the impact of these complications on mortality, and their possible correlation with TBI severity.

Methods

Observational retrospective cohort study, in one multidisciplinary intensive care unit of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale [GCS] < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded.

Results

Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (PaO2/FiO2 <200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that GOS at 1 year was independently associated with age, initial GCS 3-5, worst Traumatic Coma Data Bank (TCDB) first Computed Tomography (CT) scan and presence of intracranial hypertension, not AKI. And, hospital mortality was independently associated with initial GSC 3-5, worst TCDB first CT scan, presence of intracranial hypertension and AKI. Presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% CI: 1.37-27.78) (p<0.02), whilst ICU hypotension increased the risk of death in patients with initial scores of 3-5 on the GCS 4.28 times (95% CI: 1.22-15.07) (p<0.05).

Conclusions

Low initial GCS, worst first CT scan, intracranial hypertension and acute kidney injury determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These adds to previous studies that non-neurological complications increase length of stay and morbidity in ICU, but does not increase mortality, with the exception of AKI and hypotension in low GCS (3-5).

Read more

« Back to Special Reports

Contact Us

We will gladly answer all or your questions about rehabilitation at Centre for Neuro Skills.

email cns@neuroskills.com

phone 1.800.922.4994
or Request a Callback


brain injury store


free brain injury newsletter


why choose cns for brain injury rehabilitation


brain injury newsletter


brain injury store