Abstract
BackgroundTo assessed the significance of thoracic injury on the 30-day mortality and outcome of traumatic brain injury (TBI).MethodsTBI patients admitted to our department were retrospectively evaluated. We developed two prognostic models based on admission predictors with logistic regression analysis to assess the significance of thoracic injuries in determining the 30-day mortality and outcome. The internal validity of the models was evaluated with the bootstrap re-sampling technique. We also validated the models in an external series of 165 patients that collected from our center. Discriminative ability was evaluated with C statistic. Calibrative ability was assessed with the Hosmer-Lemeshow test (H-L test).ResultsAmong 505 TBI patients admitted, 102 (20.2%) had thoracic injuries. Patients with a PCS ≥6 had a 3.142 and 8.065 times higher odds of mortality and poor outcome compared with patients with a PCS <6, respectively. Any one-score increase of the TTS had a 1.193 times higher odds of a poor outcome (p = 0.017). The predictive model for mortality and 30-day functional outcome both had good accuracy (AUC: 0.875; 95% confidence interval [CI], 0.841–0.910 and AUC: 0.888; 95%CI, 0.860–0.916, respectively). Internal validation showed no over optimism in any of the two models’ predictive C statistics (C statistic 0.872 for 30-day mortality and C statistic 0.884 for the 30-day neurological outcome). The external validation confirmed the discriminatory ability of these models (C statistic 0.949 (95%CI: 0.919–0.980) for 30-day mortality and C statistic 0.915 (95%CI: 0.868–0.963) for the 30-day neurological outcome). The calibration was also good for patients from the validation population (H-L test p>0.05).ConclusionThoracic injury diagnosed by CT has a negative impact on the 30-day mortality and functional outcome of TBI patients. The extent of PC and the TTS are the predictors for TBI outcome.
Highlights
Traumatic brain injury (TBI) is the leading cause of morbidity and disability among trauma groups, and is responsible for a notable proportion of all traumatic deaths, in young adults [1,2]
Several studies have demonstrated that hypoxemia constitutes a secondary insult that could be related to poor outcome in traumatic brain injury (TBI) patients [7,8,9]
All participants provide their written informed consent to participate in this study, and the consent procedure was approved by the Scientific and Ethical Committee of Shanghai JiaoTong University
Summary
Traumatic brain injury (TBI) is the leading cause of morbidity and disability among trauma groups, and is responsible for a notable proportion of all traumatic deaths, in young adults [1,2]. Despite advances in pulmonary care and ventilator management, TBI has been described as contributing to higher mortality and morbidity in patients with thoracic injuries, in children [4,5]. Performing chest CT allows for an easy diagnosis of thoracic injuries, which can generate worsening of gas exchanges and acute respiratory failure. This can further result in hypoxemia, which may aggravate TBI despite adequate management of patients. We developed two prognostic models based on admission predictors with logistic regression analysis to assess the significance of thoracic injuries in determining the 30-day mortality and outcome. The external validation confirmed the discriminatory ability of these models (C statistic 0.949 (95%CI: 0.919–0.980) for 30-day mortality and C statistic 0.915 (95%CI: 0.868–0.963) for the 30-day neurological outcome). The extent of PC and the TTS are the predictors for TBI outcome
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