Mark Schieren1, Frank Wappler2, Arasch Wafaisade3, Rolf Lefering4, Samir G Sakka5, Jost Kaufmann6, Hi-Jae Heiroth7, Jerome Defosse2, Andreas B Böhmer2. 1. Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany. mark.schieren@uni-wh.de. 2. Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany. 3. Department of Traumatology and Orthopedic Surgery, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany. 4. IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany. 5. Department of Intensive Care Medicine, University of Mainz, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany. 6. Department of Pediatric Anaesthesiology, University Witten/Herdecke, Children Hospital Amsterdamer Straße, Cologne, Germany. 7. Department of Neurosurgery, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany.
Abstract
BACKGROUND: Traumatic brain injury (TBI) is associated with high rates of long-term disability and mortality. Our aim was to investigate the effects of thoracic trauma on the in-hospital course and outcome of patients with TBI. METHODS: We performed a matched pair analysis of the multicenter trauma database TraumaRegisterDGU® (TR-DGU) in the 5-year period from 2012 to 2016. We included adult patients (≥18 years of age) with moderate to severe TBI (abbreviated injury scale (AIS)= 3-5). Patients with isolated TBI (group 1) were compared to patients with TBI and varying degrees of additional blunt thoracic trauma (AISThorax= 2-5) (group 2). Matching criteria were gender, age, severity of TBI, initial GCS and presence/absence of shock. The χ2-test was used for comparing categorical variables and the Mann-Whitney-U-test was chosen for continuous parameters. Statistical significance was defined by a p-value < 0.05. RESULTS: A total of 5414 matched pairs (10,828 patients) were included. The presence of additional thoracic injuries in patients with TBI was associated with a longer duration of mechanical ventilation and a prolonged ICU and hospital length of stay. Additional thoracic trauma was also associated with higher mortality rates. These effects were most pronounced in thoracic AIS subgroups 4 and 5. Additional thoracic trauma, regardless of its severity (AISThorax ≥2) was associated with significantly decreased rates of good neurologic recovery (GOS = 5) after TBI. CONCLUSIONS: Chest trauma in general, regardless of its initial severity (AISThorax= 2-5), is associated with decreased chance of good neurologic recovery after TBI. Affected patients should be considered "at risk" and vigilance for the maintenance of optimal neuro-protective measures should be high.
BACKGROUND:Traumatic brain injury (TBI) is associated with high rates of long-term disability and mortality. Our aim was to investigate the effects of thoracic trauma on the in-hospital course and outcome of patients with TBI. METHODS: We performed a matched pair analysis of the multicenter trauma database TraumaRegisterDGU® (TR-DGU) in the 5-year period from 2012 to 2016. We included adult patients (≥18 years of age) with moderate to severe TBI (abbreviated injury scale (AIS)= 3-5). Patients with isolated TBI (group 1) were compared to patients with TBI and varying degrees of additional blunt thoracic trauma (AISThorax= 2-5) (group 2). Matching criteria were gender, age, severity of TBI, initial GCS and presence/absence of shock. The χ2-test was used for comparing categorical variables and the Mann-Whitney-U-test was chosen for continuous parameters. Statistical significance was defined by a p-value < 0.05. RESULTS: A total of 5414 matched pairs (10,828 patients) were included. The presence of additional thoracic injuries in patients with TBI was associated with a longer duration of mechanical ventilation and a prolonged ICU and hospital length of stay. Additional thoracic trauma was also associated with higher mortality rates. These effects were most pronounced in thoracic AIS subgroups 4 and 5. Additional thoracic trauma, regardless of its severity (AISThorax ≥2) was associated with significantly decreased rates of good neurologic recovery (GOS = 5) after TBI. CONCLUSIONS:Chest trauma in general, regardless of its initial severity (AISThorax= 2-5), is associated with decreased chance of good neurologic recovery after TBI. Affected patients should be considered "at risk" and vigilance for the maintenance of optimal neuro-protective measures should be high.
Authors: Jesús Abelardo Barea-Mendoza; Mario Chico-Fernández; Manuel Quintana-Díaz; Jon Pérez-Bárcena; Luís Serviá-Goixart; Ismael Molina-Díaz; María Bringas-Bollada; Antonio Luis Ruiz-Aguilar; María Ángeles Ballesteros-Sanz; Juan Antonio Llompart-Pou Journal: J Clin Med Date: 2022-01-05 Impact factor: 4.241