scholarly journals Effect of Pre-Hospital Intubation in Patients with Severe Traumatic Brain Injury on Outcome: A Prospective Cohort Study

2019 ◽  
Vol 8 (4) ◽  
pp. 470 ◽  
Author(s):  
Caroline Choffat ◽  
Cecile Delhumeau ◽  
Nicolas Fournier ◽  
Patrick Schoettker
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Prospective Cohort Study ◽  
Severe Traumatic Brain Injury ◽  
Prospective Cohort ◽  
Injury Severity ◽  
Impaired Consciousness ◽  
Pupil Reaction

Secondary injuries are associated with bad outcomes in the case of severe traumatic brain injury (sTBI). Patients with a Glasgow Coma Scale (GCS) < 9 should undergo pre-hospital intubation (PHI). There is controversy about whether PHI is beneficial. The aim of this study was to estimate the effect of PHI in patients after sTBI. A multicenter, prospective cohort study was performed in Switzerland, including 832 adults with sTBI. Outcomes were death and impaired consciousness at 14 days. Associations between risk factors and outcomes were assessed with univariate and multivariate Cox models for survival, and univariate and multivariate regression models for impaired consciousness. Potential risk factors were age, GCS on scene, pupil reaction, Injury Severity Score (ISS), PHI, oxygen administration, and type of admission to trauma center. Age, GCS on scene < 9, abnormal pupil reaction and ISS ≥ 25 were associated with mortality. GCS < 9 and ISS ≥ 25 were correlated with impaired consciousness. PHI was overall not associated with short-term mortality and consciousness. However, there was a significative interaction with PHI and major trauma. PHI improves outcome from patients with sTBI and an ISS ≥ 25.

scholarly journals Mood after Moderate and Severe Traumatic Brain Injury: A Prospective Cohort Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. e87414 ◽  
Author(s):  
Linda Valk-Kleibeuker ◽  
Majanka H. Heijenbrok-Kal ◽  
Gerard M. Ribbers
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Prospective Cohort Study ◽  
Severe Traumatic Brain Injury ◽  
Prospective Cohort

scholarly journals Can trauma surgeons keep up? A prospective cohort study comparing outcomes between patients with traumatic brain injury cared for in a trauma versus neuroscience intensive care unit

2019 ◽  
Vol 4 (1) ◽  
pp. e000229 ◽  
Author(s):  
Derek J Roberts ◽  
Samuel D Leonard ◽  
Deborah M Stein ◽  
George W Williams ◽  
Charles E Wade ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Intensive Care ◽  
Brain Injury ◽  
Scale Score ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
High Speed ◽  
Injury Severity ◽  
Level Of Evidence

BackgroundAlthough many patients with traumatic brain injury (TBI) are admitted to trauma intensive care units (ICUs), some question whether outcomes would improve if their care was provided in neurocritical care units. We sought to compare characteristics and outcomes of patients with TBI admitted to and cared for in a trauma versus neuroscience ICU.MethodsWe conducted a prospective cohort study of adult (≥18 years of age) blunt trauma patients with TBI admitted to a trauma versus neuroscience ICU between May 2015 and December 2016. We used multivariable logistic regression to estimate an adjusted odds ratio (OR) comparing 30-day mortality between cohorts.ResultsIn total, 548 patients were included in the study, including 207 (38%) who were admitted to the trauma ICU and 341 (62%) to the neuroscience ICU. When compared with neuroscience ICU admissions, patients admitted to the trauma ICU were more likely to have sustained their injuries from a high-speed mechanism (71% vs. 34%) and had a higher Injury Severity Score (ISS) (median 25 vs. 16) despite a similar head Abbreviated Injury Scale score (3 vs. 3, p=0.47) (all p<0.05). Trauma ICU patients also had a lower initial Glasgow Coma Scale score (5 vs. 15) and systolic blood pressure (128 mm Hg vs. 136 mm Hg) and were more likely to have fixed or unequal pupils at admission (13% vs. 8%) (all p<0.05). After adjusting for age, ISS, a high-speed mechanism of injury, fixed or unequal pupils at admission, and field intubation, the odds of 30-day mortality was 70% lower among patients admitted to the trauma versus neuroscience ICU (adjusted OR=0.30, 95% CI 0.11 to 0.82).ConclusionsDespite a higher injury burden and worse neurological examination and hemodynamics at presentation, patients admitted to the trauma ICU had a lower adjusted 30-day mortality. This finding may relate to improved care of associated injuries in trauma versus neuroscience ICUs.Level of evidenceProspective comparative study, level II.

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