In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

Settervall, Cristina Helena Costanti; Sousa, Regina Márcia Cardoso de; Silva, Silvia Cristina FÃ1⁄4rbringer E.

doi:10.1590/s0104-11692011000600009

Cited by 14 publications

(11 citation statements)

References 21 publications

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“…In effect, it can lead into a difference in the mean age of patients with TBI. Also, the higher frequency of severe TBI related to RTAs especially motorcycles in Isfahan (79.40%) than some other studies in New Zealand (71%),[ 17 ] India (48.91%),[ 11 ] Brazil (60.3%),[ 18 ] and Tanzania (70.8%)[ 19 ] can be due to the fact that in Isfahan (1) there is much traffic in the external highways as it is connecting many cities, (2) the majority of motor vehicles are not safe,[ 20 ] and (3) many people are not following traffic rules as well as in Iran. Despite the fact that wearing helmets is mandatory, the executers are not harsh to this matter, so that in a study by Modaghegh et al .…”

Section: Discussionmentioning

confidence: 85%

Association between Outcome of severe traumatic brain injury and demographic, clinical, injury-related variables of patients

Ziaeirad

Alimohammadi

Irajpour

et al. 2018

Iranian J Nursing Midwifery Res

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Background:Traumatic brain injury (TBI) is a main health problem among communities. There exists a variety of effective factors on the outcome of patients with TBI. We describe the demographic, clinical, and injury related variables of the patients with severe TBI, and determine the predictors of outcome.Materials and Methods:We did this cross-sectional study on all 267 adult patients with severe TBI admitted to three trauma centers of Isfahan University of Medical Sciences (IUMS) from March 20, 2014 to March 19, 2015. Data were extracted from patients' profiles. We considered the patients' outcome as discharged and died. We analyzed the collected data using descriptive (frequency, mean, and standard deviation) and analytical (independent t-test, Mann–Whitney U-test, Kruskal–Wallis test and logistic regression) statistics in Statistical Package for the Social Sciences (SPSS) 16.0. We considered p < 0.05 as the significance level.Results:The mean (SD) age of patients was 43.86 (18.40) years. The majority of the population was men (87.27%). Road traffic accidents (RTAs) were the most common mechanism of trauma (79.40%). The mean (SD) of Glasgow coma scale (GCS) was 6.03 (3.11). In 50.19% of the patients, the pupillary reflex was absent. One hundred and twenty-four patients (46.44%) died before discharge. We found age, gender, GCS, pupillary reflex, hypernatremia, and increased intracranial pressure (IICP) as the predictors of death in severe TBI.Conclusions:In this study, the mortality rate of patients with severe TBI was high. In addition, some factors were determined as the significant predictors of outcome. The findings can assist in planning to enhance the quality of care and reduce the mortality rate in the patients with severe TBI.

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Section: Discussionmentioning

confidence: 85%

Association between Outcome of severe traumatic brain injury and demographic, clinical, injury-related variables of patients

Ziaeirad

Alimohammadi

Irajpour

et al. 2018

Iranian J Nursing Midwifery Res

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“…La escala de coma de Glasgow evalúa el nivel de consciencia y la gravedad del traumatismo, por eso es de gran valía en la atención al traumatizado para estimar el pronóstico de la víctima (14,19) . Esa escala también es utilizada para evaluar la relación del tiempo-respuesta en la atención, de acuerdo con la necesidad del paciente (14) .…”

Section: Discusionesunclassified

Perfil epidemiológico das emergências traumáticas assistidas por um serviço pré-hospitalar móvel de urgencia

Gomes

Silva

Miranda

et al. 2016

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Objetivo: Describir el perfil epidemiológico de las emergencias traumáticas asistidas por un servicio de urgencia prehospitalaria móvil en el Nordeste de Brasil. Métodos: Estudio documental y cuantitativo, realizado a partir de registros de asistencia de las urgencias entre enero y junio de 2014 y la muestra se compone de 1.960 fichas. Se utilizó un cuestionario estructurado para recopilación de datos y el análisis fue por estadística descriptiva. Resultados: Destacaron los Accidentes de Tráfico (AT) - 67,7%; caídas (17,1%); y perforación por armas de fuego (6,8%). La mayoría de los involucrados eran hombres (76,2%), encuadrados en el grupo de edad jóvenes adultos (46,6%) y el mayor número de ocurrencias fue el fin de semana (37,4%). De éstas, 58,1% tuvieron traumatismo leve y el 44,0% no sufrió politraumatismo. Se observó que hubo negligencia con respecto a la anotación de la escala de coma de Glasgow en 39,0% de los casos. Conclusión: Entre las emergencias traumáticas atendidas, los AT ocurrieron en mayor proporción en domingo, involucrando adultos jóvenes de sexo masculino. Se destaca que la negligencia de los profesionales en cuanto a las anotaciones básicas en losl registros de asistencia son responsables por generar dificultades para el desarrollo de la investigación. Y con respecto a los procesos judiciales, está claro que no hay soporte documental en cuanto a la asistencia prestada.

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“…An interval of 72 h between time of injury and WLSM is sometimes used to determine both the initial effect of an injury and the subsequent trajectory of early treatment response [6][7][8]. The Joint Professional Standards committee and the Neurocritical Care Society (NCS) have also recommended an observation period of up to 72 h in patients with devastating brain injury before WLSM is considered [9].…”

Section: Introductionmentioning

confidence: 99%

“…However, intracranial surgery and extracranial surgery were less often performed in the early WLSM group compared to the later WLSM group (34 and 12% versus 58 and 22%, respectively). The maximum TIL score during ICU stay was lower in the early WLSM group compared to the later WLSM group (median [IQR] 5[1][2][3][4][5][6][7][8][9][10][11] versus10 [6.50-15]). Decisions to withdraw LSM were made in consultation with a relative in 17% of the early WLSM group and in 15% in the later WLSM group (Table…”

mentioning

confidence: 99%

Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study

et al. 2021

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Background: In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). Methods:The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (< 72 h after injury) versus later (≥ 72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed effects) logistic regression.Results: A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n = 267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.3-12.4) or two unreactive pupils (OR 5.8, CI 2.6-13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41 = 1.1, CI 1.0-1.1). Timing of WLSM was not significantly associated with region or center. Conclusion:WLSM occurs early in half of the patients, mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. We found no regional or center influences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.

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In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

Cited by 14 publications

References 21 publications

Association between Outcome of severe traumatic brain injury and demographic, clinical, injury-related variables of patients

Association between Outcome of severe traumatic brain injury and demographic, clinical, injury-related variables of patients

Perfil epidemiológico das emergências traumáticas assistidas por um serviço pré-hospitalar móvel de urgencia

Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study

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