The delayed detection of an acute neurological worsening increases traumatic brain injury lethality.
Abstract
Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury.
Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables.
Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05.
Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%.
Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.
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References
Menon DK, Schwab K, Wright DW, Maas AI. Position statement: Definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91:1637-40. https://doi.org/10.1016/j.apmr.2010.05.017
Rovegno M, Soto PA, Sáez JC, von Bernhardi R. Mecanismos biológicos involucrados en la propagación del daño en el traumatismo encéfalo craneano. Medicina Intensiva. 2012;36:37-44. https://doi.org/10.1016/j.medin.2011.06.008
Summers CR, Ivins B, Schwab KA. Traumatic brain injury in the United States: An epidemiologic overview. Mt Sinai J Med. 2009;76:105-10. https://doi.org/10.1002/msj.20100
Corrigan JD, Selassie AW, Orman JL. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25:72-80. https://doi.org/10.1097/HTR.0b013e3181ccc8b4
de Almeida CE, de Sousa Filho JL, Dourado JC, Gontijo PA, Dellaretti MA, Costa BS. Traumatic brain injury epidemiology in Brazil. World Neurosurg. 2016;87:540-7. https://doi.org/10.1097/TA.0b013e318275473c
Instituto Nacional de Medicina Legal y Ciencias Forenses. Boletín Epidemiológico de Muertes en Accidentes de Tránsito. Barranquilla; 2011. Fecha de consulta: 4 de noviembre de 2016. Disponible en: http://www.medicinalegal.gov.co/documents/10180/31296/4+BoletinmuertesentransitoBarranquilla2011.pdf/e59d0d96-c142-4084-91ff-304da866590d
Estupiñán N, Bank C-D, Urban A, Palacios A. Motorcycle ownership and use: The case of Latin America. Fecha de consulta: 21 de febrero de 2017. Disponible en: https://www.academia.edu/3856834/Motorcycle_ownership_and_use_The_case_of_Latin_America_Nicolas_Estupinan_et_al
Ropper AH, Gorson KC. Concussion. N Engl J Med. 2007;356:166-72. https://doi.org/10.1056/NEJMcp064645
Burda JE, Bernstein AM, Sofroniew MV. Astrocyte roles in traumatic brain injury. Exp Neurol. 2016;275:305-15. https://doi.org/10.1016/j.expneurol.2015.03.020
Sociedad Argentina de Terapia Intensiva. Terapia intensiva. Quinta edición. Buenos Aires: Editorial Médica Panamericana; 2015. p. 1688.
Sheriff FG, Hinson HE. Pathophysiology and clinical management of moderate and severe traumatic brain injury in the ICU. Semin Neurol. 2015;35:42-9. https://doi.org/10.1055/s-0035-1544238
Carney N, Totten AM, Hawryluk GWJ, Bell MJ, Bratton SL, Chesnut R, et al. Guidelines for the management of severe traumatic brain injury. Fourth edition. Neurosurgery. 2017;80:6-15. https://doi.org/10.1227/NEU.0000000000001432
Matis G, Birbilis T. The Glasgow Coma Scale – a brief review past, present, future. Acta Neurol Belg. 2008;108:75-89. https://doi.org/10.1007/s00134-015-4124-3
Petroni G, Quaglino M, Lujan S, Kovalevski L, Rondina C, Videtta W, et al. Early prognosis of severe traumatic brain injury in an urban Argentinian trauma center. J Trauma. 2010;68:564-70. https://doi.org/10.1097/TA.0b013e3181ce1eed
Papa L, Wang KK. Raising the bar for traumatic brain injury methods make a difference. J Neurotrauma. 2017;3:1-3. https://doi.org/10.1089/neu.2017.5030
Sanjuan AR, Silvera EC, Villa GV, Villalba P. Revisión de tema: biomarcadores neuronales y gliales como estrategia de clasificación cuantitativa de la severidad del trauma craneoencefálico. Rev Científica Salud Uninorte. 2016;32:302-18.
Ministerio de Transporte. Anuario Transporte en Cifras - Estadísticas 2014. Fecha de consulta: 21 de febrero de 2017. Disponible en: https://www.mintransporte.gov.co/descargar.php?idFile=12621
Gobierno Nacional República de Colombia. Ley 1696 de 19 de diciembre de 2013. Fecha de consulta: 21 de febrero de 2017. Disponible en: http://wsp.presidencia.gov.co/Normativa/Leyes/Documents/2013/LEY 1696 DEL 19 DE DICIEMBRE DE 2013.pdf
Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Li L, et al. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in Northeastern Japan. Acad Radiol. 2014;21:605-11. https://doi.org/10.1016/j.acra.2014.01.017
Salmaso N, Jablonska B, Scafidi J, Vaccarino FM, Gallo V. Neurobiology of premature brain injury. Nat Neurosci. 2014;17:341-6. https://doi.org/10.1038/nn.3604
Jagoda AS, Bazarian JJ, Bruns JJ, Cantrill SV, Gean AD, Howard PK, et al. Clinical policy: Neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714-48. https://doi.org/10.1016/j.annemergmed.2008.08.021
Undén J, Ingebrigtsen T, Romner B. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: An evidence and consensus-based update. BMC Med. 2013;11:50. https://doi.org/10.1186/1741-7015-11-50
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