OBJECTIVES: To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: National Trauma Data Bank. PATIENTS: Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Demographics, mechanism of injury, hospital course, and facility characteristics were examined. Admission characteristics associated with discharge outcomes were analyzed using multivariable Poisson regression models. Of 114,066 patients, most were white (62%), male (69%), and had median admission Glasgow Coma Scale score of 12 (interquartile range, 10-13). Seventy-seven percent had isolated traumatic brain injury. Concussion, which accounted for 25% of moderate traumatic brain injury, was the most frequent traumatic brain injury diagnosis. Fourteen percent received mechanical ventilation, and 66% were admitted to ICU. Over 50% received care at a community hospital. Seven percent died, and 32% had a poor outcome, including those with Glasgow Coma Scale score of 13. Compared with patients 18-44 years, patients 45-64 years were twice as likely (adjusted relative risk, 1.97; 95% CI, 1.92-2.02) and patients over 80 years were five times as likely (adjusted relative risk, 4.66; 95% CI, 4.55-4.76) to have a poor outcome. Patients with a poor discharge outcome were more likely to have had hypotension at admission (adjusted relative risk, 1.10; 95% CI, 1.06-1.14), lower admission Glasgow Coma Scale (adjusted relative risk, 1.37; 95% CI, 1.34-1.40), higher Injury Severity Score (adjusted relative risk, 2.97; 95% CI, 2.86-3.09), and polytrauma (adjusted relative risk, 1.05; 95% CI, 1.02-1.07), compared with those without poor discharge outcomes. CONCLUSIONS: Many patients with moderate traumatic brain injury deteriorate, require neurocritical care, and experience poor outcomes. Optimization of care and outcomes for this vulnerable group of patients are urgently needed.
OBJECTIVES: To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: National Trauma Data Bank. PATIENTS: Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Demographics, mechanism of injury, hospital course, and facility characteristics were examined. Admission characteristics associated with discharge outcomes were analyzed using multivariable Poisson regression models. Of 114,066 patients, most were white (62%), male (69%), and had median admission Glasgow Coma Scale score of 12 (interquartile range, 10-13). Seventy-seven percent had isolated traumatic brain injury. Concussion, which accounted for 25% of moderate traumatic brain injury, was the most frequent traumatic brain injury diagnosis. Fourteen percent received mechanical ventilation, and 66% were admitted to ICU. Over 50% received care at a community hospital. Seven percent died, and 32% had a poor outcome, including those with Glasgow Coma Scale score of 13. Compared with patients 18-44 years, patients 45-64 years were twice as likely (adjusted relative risk, 1.97; 95% CI, 1.92-2.02) and patients over 80 years were five times as likely (adjusted relative risk, 4.66; 95% CI, 4.55-4.76) to have a poor outcome. Patients with a poor discharge outcome were more likely to have had hypotension at admission (adjusted relative risk, 1.10; 95% CI, 1.06-1.14), lower admission Glasgow Coma Scale (adjusted relative risk, 1.37; 95% CI, 1.34-1.40), higher Injury Severity Score (adjusted relative risk, 2.97; 95% CI, 2.86-3.09), and polytrauma (adjusted relative risk, 1.05; 95% CI, 1.02-1.07), compared with those without poor discharge outcomes. CONCLUSIONS: Many patients with moderate traumatic brain injury deteriorate, require neurocritical care, and experience poor outcomes. Optimization of care and outcomes for this vulnerable group of patients are urgently needed.
Authors: Teuntje M J C Andriessen; Janneke Horn; Gaby Franschman; Joukje van der Naalt; Iain Haitsma; Bram Jacobs; Ewout W Steyerberg; Pieter E Vos Journal: J Neurotrauma Date: 2011-09-27 Impact factor: 5.269
Authors: Daniel Agustín Godoy; Andrés Rubiano; Alejandro A Rabinstein; Ross Bullock; Juan Sahuquillo Journal: Neurocrit Care Date: 2016-10 Impact factor: 3.210
Authors: Monica S Vavilala; Mary A Kernic; Jin Wang; Nithya Kannan; Richard B Mink; Mark S Wainwright; Jonathan I Groner; Michael J Bell; Christopher C Giza; Douglas F Zatzick; Richard G Ellenbogen; Linda Ng Boyle; Pamela H Mitchell; Frederick P Rivara Journal: Crit Care Med Date: 2014-10 Impact factor: 7.598
Authors: Jeffrey P Cuthbert; Cynthia Harrison-Felix; John D Corrigan; Scott Kreider; Jeneita M Bell; Victor G Coronado; Gale G Whiteneck Journal: J Head Trauma Rehabil Date: 2015 Mar-Apr Impact factor: 2.710
Authors: Raj G Kumar; Matthew R Kesinger; Shannon B Juengst; Maria M Brooks; Anthony Fabio; Kristen Dams-O'Connor; Mary Jo Pugh; Jason L Sperry; Amy K Wagner Journal: J Trauma Acute Care Surg Date: 2020-04 Impact factor: 3.697
Authors: Elif Soysal; Christopher M Horvat; Dennis W Simon; Michael S Wolf; Elizabeth Tyler-Kabara; Barbara A Gaines; Robert S B Clark; Patrick M Kochanek; Hülya Bayir Journal: Pediatr Crit Care Med Date: 2021-11-01 Impact factor: 3.971
Authors: Dmitry Esterov; Erica Bellamkonda; Jay Mandrekar; Jeanine E Ransom; Allen W Brown Journal: Neuroepidemiology Date: 2021-04-09 Impact factor: 5.393
Authors: Antoine Roquilly; Jean Denis Moyer; Olivier Huet; Sigismond Lasocki; Benjamin Cohen; Claire Dahyot-Fizelier; Kevin Chalard; Philippe Seguin; Caroline Jeantrelle; Véronique Vermeersch; Thomas Gaillard; Raphael Cinotti; Dominique Demeure Dit Latte; Pierre Joachim Mahe; Mickael Vourc'h; Florian Pierre Martin; Alice Chopin; Celine Lerebourg; Laurent Flet; Anne Chiffoleau; Fanny Feuillet; Karim Asehnoune Journal: JAMA Date: 2021-05-25 Impact factor: 56.272