Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients

Niemeyer, MJS; Jochems, Denise; Houwert, R Marijn; Es, MA van; Leenen, Luke P. H.; Wessem, KJP van

doi:10.1016/j.injury.2022.01.009

Cited by 17 publications

(15 citation statements)

References 19 publications

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“…Another aspect adding to the frequency of respiratory insu ciency as cause of death is the fact that Injuries to the chest were the most frequently associated injuries in both TCSI and TBI. This association of chest injuries and injuries to the cervical spine and TBI in severely injured have been reported previously as well [22,24]. The differences in cause of death between TCSI and TBI patients were also re ected by the time of death; median time to death was almost twice as long in TCSI patients compared to TBI patients.…”

Section: Discussionsupporting

confidence: 81%

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Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

Wessem

Niemeyer

Leenen

2022

Preprint

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Introduction Traumatic cervical spine injuries (TCSI) are rare injuries. With increasing age the incidence of TCSI is on the rise. TCSI and traumatic brain injury (TBI) are often associated. In calculating Injury Severity Score (ISS) TCSI and TBI are both included in the Abbreviated Injury Scale (AIS)head. However, outcome of TCSI and TBI might be different through the nature of the injuries. In this retrospective monocenter study the incidence and outcome of TCSI in polytrauma was investigated and compared to TBI. Methods Consecutive polytrauma patients aged > 15 years with AIShead > 3 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2015–2021 were included. Demographics, treatment, and outcome parameters were analyzed for patients who had AIShead ≥ 3 based on TCSI and compared to patients with AIShead ≥ 3 based on proper TBI. Data on follow-up were collected for TCSI patients. Results Two hundred eighty-seven polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIS head ≥ 3 were included; Thirty-four patients (12%) had AIShead ≥ 3 based on TCSI whereas 253( 88%) had AIShead ≥ 3 based on TBI. TCSI patients were slightly older, had lower systolic blood pressure in the Emergency Department (ED) and stayed longer in ICU than TBI patients. There was no difference in morbidity and mortality rates. The majority of TCSI patients died of respiratory insufficiency, whereas TBI patients died primarily of TBI. TCSI was mainly located at C2, 59% had associated spinal cord injury, and 9% had associated severe TBI. Median follow-up time was 24 months. Twenty percent had improvement of the spinal cord injury, and 15% died during follow-up. Discussion In this study the incidence of severe TCSI in polytrauma was much lower than TBI. Cause of death in TCSI was different compared to TBI demonstrating that AIShead based on TCSI is a different entity than based on TBI. In order to avoid data misinterpretation injuries to the cervical spine should be distinguished from TBI in morbidity and mortality analysis.

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Section: Discussionsupporting

confidence: 81%

“…Although patients with associated spinal cord injury had higher ISS (35 (25-57) vs. 27 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), p=0.02), there was no difference in physiological and resuscitation parameters nor any difference in morbidity and in-hospital mortality compared to patients without TSCI.…”

Section: Traumatic Spinal Cord Injury (Tsci)mentioning

confidence: 94%

Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

Wessem

Niemeyer

Leenen

2022

Preprint

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“…Post-traumatic mortality depends on the presence of hemorrhagic shock (HS) and/or traumatic brain injury (TBI). Hemorrhagic shock accounts for 30% of trauma-related mortality ( 1 ), TBI is the most prevalent cause of death after polytrauma ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

The effect of targeted hyperoxemia in a randomized controlled trial employing a long-term resuscitated, model of combined acute subdural hematoma and hemorrhagic shock in swine with coronary artery disease: An exploratory, hypothesis-generating study

Datzmann

Messerer²,

Münz³

et al. 2022

Front. Med.

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Controversial evidence is available regarding suitable targets for the arterial O2 tension (PaO2) after traumatic brain injury and/or hemorrhagic shock (HS). We previously demonstrated that hyperoxia during resuscitation from hemorrhagic shock attenuated cardiac injury and renal dysfunction in swine with coronary artery disease. Therefore, this study investigated the impact of targeted hyperoxemia in a long-term, resuscitated model of combined acute subdural hematoma (ASDH)-induced brain injury and HS. The prospective randomized, controlled, resuscitated animal investigation consisted of 15 adult pigs. Combined ASDH plus HS was induced by injection of 0.1 ml/kg autologous blood into the subdural space followed by controlled passive removal of blood. Two hours later, resuscitation was initiated comprising re-transfusion of shed blood, fluids, continuous i.v. noradrenaline, and either hyperoxemia (target PaO2 200 – 250 mmHg) or normoxemia (target PaO2 80 – 120 mmHg) during the first 24 h of the total of 54 h of intensive care. Systemic hemodynamics, intracranial and cerebral perfusion pressures, parameters of brain microdialysis and blood biomarkers of brain injury did not significantly differ between the two groups. According to the experimental protocol, PaO2 was significantly higher in the hyperoxemia group at the end of the intervention period, i.e., at 24 h of resuscitation, which coincided with a higher brain tissue PO2. The latter persisted until the end of observation period. While neurological function as assessed using the veterinary Modified Glasgow Coma Score progressively deteriorated in the control group, it remained unaffected in the hyperoxemia animals, however, without significant intergroup difference. Survival times did not significantly differ in the hyperoxemia and control groups either. Despite being associated with higher brain tissue PO2 levels, which were sustained beyond the intervention period, targeted hyperoxemia exerted neither significantly beneficial nor deleterious effects after combined ASDH and HS in swine with pre-existing coronary artery disease. The unavailability of a power calculation and, thus, the limited number of animals included, are the limitations of the study.

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“…patients were identified by the following criteria: Glasgow Coma Scale (GCS) score between 3 and 8 at scene of injury, Abbreviated Injury Scale (AIS) severity score for head injuries of 3 or more and Injury Severity Score (ISS) of 13 or more [12]. Hence, GCS (3)(4)(5)(6)(7)(8), AIS head injury (3 or more) and ISS (13 or more) had to be present in order to be included.…”

Section: Study Populationmentioning

confidence: 99%

Incidence, Mechanisms of Injury and Mortality of Severe Traumatic Brain Injury: An Observational Population‐Based Cohort Study from New Zealand and Norway

Weber

Andreassen

Isles³

et al. 2022

World j. surg.

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Background Comparing trauma registry data from different countries can help to identify possible differences in epidemiology, which may help to improve the care of trauma patients. Methods This study directly compares the incidence, mechanisms of injuries and mortality of severe TBI based on population-based data from the two national trauma registries from New Zealand and Norway. All patients prospectively registered with severe TBI in either of the national registries for the 4-year study period were included. Patient and injury variables were described and age-adjusted incidence and mortality rates were calculated. Results A total of 1378 trauma patients were identified of whom 751 (54.5%) from New Zealand and 627 (45.5%) from Norway. The patient cohort from New Zealand was significantly younger (median 32 versus 53 years; p < 0.001) and more patients from New Zealand were injured in road traffic crashes (37% versus 13%; p < 0.001). The age-adjusted incidence rate of severe TBI was 3.8 per 100,000 in New Zealand and 2.9 per 100,000 in Norway. The age-adjusted mortality rates were 1.5 per 100,000 in New Zealand and 1.2 per 100,000 in Norway. The fatality rates were 38.5% in New Zealand and 34.2% in Norway (p = 0.112). Conclusions Road traffic crashes in younger patients were more common in New Zealand whereas falls in elderly patients were the main cause for severe TBI in Norway. The age-adjusted incidence and mortality rates of severe TBI among trauma patients are similar in New Zealand and Norway. The fatality rates of severe TBI are still considerable with more than one third of patients dying.

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Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients

Cited by 17 publications

References 19 publications

Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

The effect of targeted hyperoxemia in a randomized controlled trial employing a long-term resuscitated, model of combined acute subdural hematoma and hemorrhagic shock in swine with coronary artery disease: An exploratory, hypothesis-generating study

Incidence, Mechanisms of Injury and Mortality of Severe Traumatic Brain Injury: An Observational Population‐Based Cohort Study from New Zealand and Norway

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