Journal of neurosurgical sciences · 2024
Comparing survival and outcomes in isolated versus polytrauma-associated TBI: a retrospective cohort study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Corbella Davide, Zangari Rosalia, Biroli Francesco, Magnone Stefano, Cavalleri Gaia, Passoni Maurizio, Martchenko Svetlana, Marchesi Silvia, Zacchetti Lucia, Ferri Francesco, Urbaz Laura, Aliprandi Marco, Lorini Luca F, Gritti Paolo
Аннотация
BACKGROUND: One in four patients with moderate to severe traumatic brain injury (TBI) also has other body district injuries (OBD). The impact of OBD on mortality and disability is debated. This study compared outcomes of TBI patients with polytrauma (p-TBI) versus isolated TBI (alone-TBI) and identified outcome determinants, focusing on survival time and prognosis.
METHODS: This single-center, retrospective cohort study analyzed 193 patients with moderate to severe TBI admitted to an ICU from 2011 to 2012. Patients were divided into p-TBI and alone-TBI groups. Clinical, demographic, and outcome data were extracted from medical records. Key outcomes included survival time and Glasgow Outcome Scale-Extended (GOSE) scores at 1-year.
RESULTS: The alone-TBI group (N.=126) was older with more comorbidities and higher use of antiplatelet/anticoagulant medications. The p-TBI group (N.=67) had greater physiological dysfunction (hypotension, acidosis, anemia, coagulopathy). Trauma severity (Glasgow Coma Scale), in-hospital mortality, and GOSE were similar between groups, but p-TBI patients had a shorter median survival time (3.5 vs. 18 days, P=0.016). Key determinants of poor outcomes were age, coagulopathy, neurological impairment at admission, and intracranial hypertension.
CONCLUSIONS: Polytrauma does not appear to be independently associated with the prognosis of moderate to severe TBI patients but is associated with earlier mortality. Coagulopathy and physiological instability are more critical factors in determining mortality and poor outcomes. Future research should explore whether polytrauma is a bystander in TBI or if it has a causal role in adverse outcomes.
METHODS: This single-center, retrospective cohort study analyzed 193 patients with moderate to severe TBI admitted to an ICU from 2011 to 2012. Patients were divided into p-TBI and alone-TBI groups. Clinical, demographic, and outcome data were extracted from medical records. Key outcomes included survival time and Glasgow Outcome Scale-Extended (GOSE) scores at 1-year.
RESULTS: The alone-TBI group (N.=126) was older with more comorbidities and higher use of antiplatelet/anticoagulant medications. The p-TBI group (N.=67) had greater physiological dysfunction (hypotension, acidosis, anemia, coagulopathy). Trauma severity (Glasgow Coma Scale), in-hospital mortality, and GOSE were similar between groups, but p-TBI patients had a shorter median survival time (3.5 vs. 18 days, P=0.016). Key determinants of poor outcomes were age, coagulopathy, neurological impairment at admission, and intracranial hypertension.
CONCLUSIONS: Polytrauma does not appear to be independently associated with the prognosis of moderate to severe TBI patients but is associated with earlier mortality. Coagulopathy and physiological instability are more critical factors in determining mortality and poor outcomes. Future research should explore whether polytrauma is a bystander in TBI or if it has a causal role in adverse outcomes.