Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients

Mjs Niemeyer,D Jochems,Rm Houwert,Ma Van Es,Lph Leenen,Kjp Van Wessem

doi:10.1016/j.injury.2022.01.009

Mjs Niemeyer, D Jochems + Show 4 more

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https://doi.org/10.1016/j.injury.2022.01.009

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Journal: Injury	Publication Date: Jan 5, 2022
Citations: 12	License type: cc-by

Affiliation: University Medical Center Utrecht

Abstract

BackgroundMortality caused by Traumatic Brain Injury (TBI) remains high, despite improvements in trauma and critical care. Polytrauma is naturally associated with high mortality. This study compared mortality rates between isolated TBI (ITBI) patients and polytrauma patients with TBI (PTBI) admitted to ICU to investigate if concomitant injuries lead to higher mortality amongst TBI patients. MethodsA 3-year cohort study compared polytrauma patients with TBI (PTBI) with AIS head ≥3 (and AIS of other body regions ≥3) from a prospective collected database to isolated TBI (ITBI) patients from a retrospective collected database with AIS head ≥3 (AIS of other body regions ≤2), both admitted to a single level-I trauma center ICU. Patients <16 years of age, injury caused by asphyxiation, drowning, burns and ICU transfers from and to other hospitals were excluded. Patient demographics, shock and resuscitation parameters, multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), and mortality data were collected and analyzed for group differences. Results259 patients were included; 111 PTBI and 148 ITBI patients. The median age was 54 [33-67] years, 177 (68%) patients were male, median ISS was 26 [20-33]. Seventy-nine (31%) patients died. Patients with PTBI developed more ARDS (7% vs. 1%, p = 0.041) but had similar MODS rates (18% vs. 10%, p = 0.066). They also stayed longer on the ventilator (7 vs. 3 days, p=<0.001), longer in ICU (9 vs. 4 days, p=<0.001) and longer in hospital (24 vs. 11 days, p=<0.001). TBI was the most prevalent cause of death in polytrauma patients. Patients with PTBI showed no higher in-hospital mortality rate. Moreover, mortality rates were skewed towards ITBI patients (24% vs. 35%, p = 0.06). DiscussionThere was no difference in mortality rates between PTBI and ITBI patients, suggesting TBI-severity as the predominant factor for ICU mortality in an era of ever improving acute trauma care.

Highlights

Traumatic brain injury (TBI) poses a major global health challenge with the highest morbidity and mortality rates among trauma patients, estimated at 69 million patients suffering from severe Traumatic Brain Injury (TBI) per annum [1]
Over the three-year study period, 259 eligible patients were admitted to intensive care unit (ICU) with 111 patients with TBI (PTBI) patients and 148 isolated TBI (ITBI) patients
In-hospital mortality was similar for both groups, PTBI patients suffered from concomitant injuries, stayed longer on the ventilator, in ICU and in hospital

Summary

Introduction

Traumatic brain injury (TBI) poses a major global health challenge with the highest morbidity and mortality rates among trauma patients, estimated at 69 million patients suffering from severe TBI per annum [1]. Treatment of severely injured patients demands specialized and well-developed trauma and intensive care unit (ICU) systems These were successfully developed over the previous decades to improve morbidity and mortality in polytrauma patients [4]. Such advancements may have contributed to the decline in mortality from exsanguination, acute respiratory distress syndrome (ARDS) and multi-organ dysfunction syndrome (MODS), leaving central nervous system-related mortality as most prevalent cause of death in trauma [5,6]. Discussion: There was no difference in mortality rates between PTBI and ITBI patients, suggesting TBIseverity as the predominant factor for ICU mortality in an era of ever improving acute trauma care

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