Prognostic value of secondary insults in traumatic brain injury: Results from the IMPACT study

Gillian S. McHugh, Doortje C. Engel, Isabella Butcher, Ewout W. Steyerberg, Juan Lu, Nino Mushkudiani, Adrian V. Hernández, Anthony Marmarou, Andrew I.R. Maas, Gordon D. Murray

Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

234 Citas (Scopus)

Resumen

We determined the relationship between secondary insults (hypoxia, hypotension, and hypothermia) occurring prior to or on admission to hospital and 6-month outcome after traumatic brain injury (TBI). A meta-analysis of individual patient data, from seven Phase III randomized clinical trials (RCT) in moderate or severe TBI and three TBI population-based series, was performed to model outcome as measured by the Glasgow Outcome Scale (GOS). Proportional odds modeling was used to relate the probability of a poor outcome to hypoxia (N = 5661), hypotension (N = 6629), and hypothermia (N = 4195) separately. We additionally analyzed the combined effects of hypoxia and hypotension and performed exploratory analysis of associations with computerized tomography (CT) classification and month of injury. Having a pre-enrollment insult of hypoxia, hypotension or hypothermia is strongly associated with a poorer outcome (odds ratios of 2.1 95% CI [1.7-2.6], 2.7 95% CI [2.1-3.4], and 2.2 95% CI [1.6-3.2], respectively). Patients with both hypoxia and hypotension had poorer outcomes than those with either insult alone. Radiological signs of raised intracranial pressure (CT class III or IV) were more frequent in patients who had sustained hypoxia or hypotension. A significant association was observed between month of injury and hypothermia. The occurrence of secondary insults prior to or on admission to hospital in TBI patients is strongly related to poorer outcome and should therefore be a priority for emergency department personnel.

Idioma originalInglés
Páginas (desde-hasta)287-293
Número de páginas7
PublicaciónJournal of Neurotrauma
Volumen24
N.º2
DOI
EstadoPublicada - feb 2007
Publicado de forma externa

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