Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury

Abstract

Introduction Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included. Exclusion criteria were isolated spinal cord injury and referrals to and from other hospitals. Gathered data included demographics, mortality, cause of death, WLST, and Glasgow Outcome Scale (GOS) score after three months. Good functional outcome was defined as GOS > 3. Results Of 367 patients, 179 patients were included after applying inclusion and exclusion criteria. 55 died during admission (33%), of whom 45 (82%) after WLST. Patients undergoing WLST were older, had worse neurological performance at presentation, and had more radiological abnormalities than patients without WLST. The decision to withdraw life-sustaining treatment was made on the day of admission in 40% of patients. In 33% of these patients, this decision was made while the patient was in the Emergency Department. 71% of survivors had a good functional outcome after three months. No patient left hospital with an unresponsive wakefulness syndrome (UWS) or suffered from UWS after three months. One patient died within three months of discharge. Conclusion In-hospital mortality in isolated brain injured patients was 33%. The vast majority died after a decision to withdraw life-sustaining treatment. None of the patients were discharged with an unresponsive wakefulness syndrome.

The evolution of trauma care in the Netherlands over 20 years

“…In 1999 the Netherlands implemented an inclusive trauma system, which organized the country in 11 trauma regions [9]. The goal of this inclusive system is to present all patients on a timely basis at the right hospital, with the centralisation of the most severely injured patients in level 1 centres [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The less severely injured patients are ideally treated at level 2 and level 3 centres.…”

“…This organizational change had a major impact on trauma care, as it did in most countries that implemented inclusive trauma systems [24,25]. The data presented in every time period is based on previous publications and where possible adjusted odd ratios presented in those publications were used [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Before centralisation (step 1) a regional mortality rate of 2.6% was documented, of which 40% died due to exsanguination.…”

“…These combined measures resulted that to date, the most important cause of death is neurotrauma (> 80%). Even more, in most cases of extensive neurotrauma it is a medical decision to stop treatment after adequate resuscitation and when a complete overview of the patients history and comorbidities is retrieved [16,17]. Finally, next to the improved mortality rates, the care for trauma patients becomes increasingly efficient.…”

Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study

“…Mild TBI presents with concussion symptoms, affecting physical, cognitive, and emotional (affective) domains. Various degrees of autonomic and neurologic dysfunctions are seen in moderate and severe TBI cases in addition to mild TBI features [23,24]. Head computed tomography (CT) is recommended for children presenting with drowsiness or decreased mentation, any sign of basal skull fracture, focal neurologic deficit, etc.…”

Pattern and Outcome of Pediatric Traumatic Brain Injury: A Prospective Cohort Study at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

“…Mild TBI presents with concussion symptoms affecting physical, cognitive, and emotional (affective) domains. Various degrees of autonomic and neurologic dysfunction are seen in moderate and severe TBI cases in addition to mild TBI features [23,24]. Head computed tomography( CT) is recommended for children presenting with drowsiness or decreased mentation, any sign of basal skull fracture, focal neurologic deficit etc [25].…”