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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Early prognostic factors for morbidity and mortality in severe traumatic brain injury. Experience in a child
M Cabrero Hernández1, M I Iglesias Bouzas1, A Martínez de Azagra Garde1
1Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
Early identification of severe traumatic brain injury (TBI) prognostic factors is crucial. Factors like prehospital Glasgow Coma Scale scores and hypoxia predict unfavorable outcomes, aiding clinical decisions.
Area of Science:
- Neuroscience
- Trauma Care
- Clinical Prognostics
Background:
- Severe traumatic brain injury (TBI) presents significant challenges in predicting patient outcomes.
- Early identification of prognostic factors is essential for timely clinical intervention and improved patient management.
Purpose of the Study:
- To identify early prognostic factors associated with an increased risk of unfavorable prognosis in patients with severe TBI.
- To establish predictive models for patient outcomes following severe TBI.
Main Methods:
- An observational cohort study was conducted from October 2002 to October 2017, including patients with severe TBI admitted to intensive care.
- Data collected included epidemiological, clinical, analytical, and therapeutic variables. Functional capacity was assessed at 6 months using the Glasgow Outcome Scale (GOS).
- Univariate and multivariate analyses were performed to identify predictors of prognosis, with unfavorable prognosis defined as GOS ≤ 3.
Main Results:
- The study included 98 patients, with 61.2% males and a median age of 6.4 years.
- At 6 months, 51% had satisfactory recovery, while 14.3% died. Significant predictors of unfavorable prognosis included prehospital Glasgow Coma Scale score, pupillary reactivity, hypotension, hypoxia, and specific radiological findings.
- Multivariate analysis confirmed the ability to develop predictive models for patient outcomes.
Conclusions:
- Early prognostic factors for poor outcomes in severe TBI can be identified within the first 24 hours post-trauma.
- Knowledge of these prognostic factors can significantly aid clinical decision-making and family communication regarding patient prognosis.
Objective:
To identify early prognostic factors that lead to an increased risk of unfavorable prognosis.
Design:
Observational cohort study from October 2002 to October 2017.
Setting And Patients:
Patients with severe TBI admitted to intensive care were included.
Variables And Interventions:
Epidemiological, clinical, analytical and therapeutic variables were collected. The functional capacity of the patient was assessed at 6 months using the Glasgow Outcome Scale (GOS). An unfavorable prognosis was considered a GOS less than or equal to 3. A univariate analysis was performed to compare the groups with good and bad prognosis and their relationship with the different variables. A multivariate analysis was performed to predict the patient's prognosis.
Results:
98 patients were included, 61.2% males, median age 6.4 years (IQR 2.49-11.23). 84.7% were treated by the out-of-hospital emergency services. At 6 months, 51% presented satisfactory recovery, 26.5% moderate sequelae, 6.1% severe sequelae, and 2% vegetative state. 14.3% died. Statistical significance was found between the score on the prehospital Glasgow coma scale, pupillary reactivity, arterial hypotension, hypoxia, certain analytical and radiological alterations, such as compression of the basal cisterns, with an unfavorable prognosis. The multivariate analysis showed that it is possible to make predictive models of the evolution of the patients.
Conclusions:
it is possible to identify prognostic factors of poor evolution in the first 24 h after trauma. Knowledge of them can help clinical decision-making as well as offer better information to families.
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