Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study

Abstract

OBJECTIVES: Traumatic brain injury is a leading cause of death and disability in the United States. While the impact of early multiple organ dysfunction syndrome has been studied in many critical care paradigms, the clinical impact of early multiple organ dysfunction syndrome in traumatic brain injury is poorly understood. We examined the incidence and impact of early multiple organ dysfunction syndrome on clinical, functional, and disability outcomes over the year following traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: Patients enrolled in the Transforming Clinical Research and Knowledge in Traumatic Brain Injury study, an 18-center prospective cohort study of traumatic brain injury patients evaluated in participating level 1 trauma centers. SUBJECTS: Adult (age > 17 yr) patients with moderate-severe traumatic brain injury (Glasgow Coma Scale < 13). We excluded patients with major extracranial injury (Abbreviated Injury Scale score ≥ 3). INTERVENTIONS: Development of early multiple organ dysfunction syndrome, defined as a maximum modified Sequential Organ Failure Assessment score greater than 7 during the initial 72 hours following admission. MEASUREMENTS AND MAIN RESULTS: The main outcomes were: hospital mortality, length of stay, 6-month functional and disability domains (Glasgow Outcome Scale-Extended and Disability Rating Scale), and 1-year mortality. Secondary outcomes included: ICU length of stay, 3-month Glasgow Outcome Scale-Extended, 3-month Disability Rating Scale, 1-year Glasgow Outcome Scale-Extended, and 1-year Disability Rating Scale. We examined 373 subjects with moderate-severe traumatic brain injury. The mean (sd) Glasgow Coma Scale in the emergency department was 5.8 (3.2), with 280 subjects (75%) classified as severe traumatic brain injury (Glasgow Coma Scale 3–8). Among subjects with moderate-severe traumatic brain injury, 252 (68%) developed early multiple organ dysfunction syndrome. Subjects that developed early multiple organ dysfunction syndrome had a 75% decreased odds of a favorable outcome (Glasgow Outcome Scale-Extended 5–8) at 6 months (adjusted odds ratio, 0.25; 95% CI, 0.12–0.51) and increased disability (higher Disability Rating Scale score) at 6 months (adjusted mean difference, 2.04; 95% CI, 0.92–3.17). Subjects that developed early multiple organ dysfunction syndrome experienced an increased hospital length of stay (adjusted mean difference, 11.4 d; 95% CI, 7.1–15.8), with a nonsignificantly decreased survival to hospital discharge (odds ratio, 0.47; 95% CI, 0.18–1.2). CONCLUSIONS: Early multiple organ dysfunction following moderate-severe traumatic brain injury is common and independently impacts multiple domains (mortality, function, and disability) over the year following injury. Further research is necessary to understand underlying mechanisms, improve early recognition, and optimize management strategies.

Recovery Degree in Pediatric Patients with Antecedent Severe Traumatic Brain Injury in Mexico

“…The Glasgow Outcome Scale (GOS) recorded, at hospital discharge the male presented, the lowest values (GOS 2 and GOS 3) and they are consistent with other studies [16,17,21,22] it found an association of sex patients with the mechanisms of injury, the level of severity and the length of hospital stay. Besides, GOS one year after hospital discharge was similar to the reported by other studies [21,22] that indicated a pathophysiological response of the brain to trauma which was higher in children and young people.…”

Initial neurocritical care of severe traumatic brain injury: New paradigms and old challenges

“…MODS, which has been estimated to occur in more than two-thirds of sTBI patients, can lead to several contraindications to NWT. [ 52 , 65 ] Neuromonitoring can indirectly detect neuroworsening through evaluating the physiologic state of brain tissue in some of these difficult scenarios. [ 19 , 57 ] In particular, recent evidence has pointed to a survival benefit of using brain tissue oxygen (B tp O 2 ) monitoring.…”

Incidence and Burden of Acute Kidney Injury among Traumatic Brain-Injury Patients

“…The incidence of nonneurological organ dysfunction developing in TBI patients is 33%-89%. [1][2][3][4] Among various kinds of organ dysfunction, acute kidney injury (AKI) has attracted wide attention, due to its unfavorable effects on cerebral edema and prognosis of TBI patients. Both injury severity and inappropriate medical strategy can promote the development of AKI in TBI patients.…”