Trends in demographics and outcome of patients presenting with traumatic brain injury

Kadar, Rachel; Rochford, Daniel; Omi, Ellen C.; Thomas, Yalaunda M.; Patel, Kunal; Kulstad, Erik

doi:10.15441/ceem.18.010

Cited by 6 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding the outcome of TBI in general, a thorough review covering the last 150 years reported no improvement in mortality since 1990, after two decades of a marked decrease in mortality rates [ 49 ]. More recent reports, however, indicate that the outcome of patients with TBI may be improving [ 20 , 26 , 27 , 31 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study

et al. 2021

View full text Add to dashboard Cite

Background Several studies have suggested no change in the outcome of patients with traumatic brain injury (TBI) treated in intensive care units (ICUs). This is mainly due to the shift in TBI epidemiology toward older and sicker patients. In Finland, the share of the population aged 65 years and over has increased the most in Europe during the last decade. We aimed to assess changes in 12-month and hospital mortality of patients with TBI treated in the ICU in Finland. Methods We used a national benchmarking ICU database (Finnish Intensive Care Consortium) to study adult patients who had been treated for TBI in four tertiary ICUs in Finland during 2003–2019. We divided admission years into quartiles and used multivariable logistic regression analysis, adjusted for case-mix, to assess the association between admission year and mortality. Results A total of 4535 patients were included. Between 2003–2007 and 2016–2019, the patient median age increased from 54 to 62 years, the share of patients having significant comorbidity increased from 8 to 11%, and patients being dependent on help in activities of daily living increased from 7 to 15%. Unadjusted hospital and 12-month mortality decreased from 18 and 31% to 10% and 23%, respectively. After adjusting for case-mix, a reduction in odds of 12-month and hospital mortality was seen in patients with severe TBI, intracranial pressure monitored patients, and mechanically ventilated patients. Despite a reduction in hospital mortality, 12-month mortality remained unchanged in patients aged ≥ 70 years. Conclusion A change in the demographics of ICU-treated patients with TBI care is evident. The outcome of younger patients with severe TBI appears to improve, whereas long-term mortality of elderly patients with less severe TBI has not improved. This has ramifications for further efforts to improve TBI care, especially among the elderly.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Case fatality rates of most acute intracranial disorders including brain hemorrhage have significantly decreased over the last decade, mainly due to better intensive care management and maybe also due to a less fatalistic attitude toward treatment at older age. 11,12,[20][21][22] Therefore, outcome of older series is difficult to compare with more recent reports. Recently, Maslehaty et al reported on a large series of 817 patients with lobar and deep ICH.…”

Section: Discussionmentioning

confidence: 99%

Profile and Prognosis of Spontaneous Lobar Intracerebral Hemorrhage: Comparison of 6-month Survival with STICH II and the MISTIE III Lobar Hemorrhage Subset

Behle

Beseoglu

Beez

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background Randomized trials on spontaneous lobar intracerebral hemorrhage (ICH) provided no convincing evidence of the superiority of surgical treatment. Since recruitment in the trials was under the premise of equipoise, a selection bias toward patients who did not need surgery or were in hopeless condition must be suspected. The aim of the actual analysis was to compare outcome and patient profile of an unselected hospital series with recent randomized trials and to develop a prognostic model. Methods Of 821 patients with spontaneous ICH managed at the neurosurgical department of the University Hospital Düsseldorf between 2013 and 2018, 159 had lobar bleedings. Patient characteristics, hematoma volume, treatment modality, and 6-month survival were compared with STICH II and the subset of lobar hemorrhage in the MISTIE III trial. In addition, a prognostic model for 6-month survival in our patients was developed using a random forest classifier. Results One hundred and seven patients were managed by surgical evacuation of the hematoma and 52 without surgical evacuation. Median hemorrhage volume in our surgical cohort was 66 and 42 mL in the conservative cohort, compared with 38 and 36 mL in the STICH II trial, and 46 and 47 mL in the surgical and conservative MISTIE III lobar hemorrhage subset. Median initial Glasgow Coma Scale (GCS) score was 12 in our surgical group and 11 in the conservative group, compared with 13 in the STICH II cohorts and 12 in the MISTIE III lobar hemorrhage subset. Median age in our surgical and conservative cohorts was 73 and 74 years, respectively, compared with 65 years in both STICH II cohorts and 68 years in the MISTIE II subsets. Twenty-nine percent of our surgical cohort and 55% of our conservatively managed patients deceased within the first 6 months, compared with 18 and 24%, respectively, in STICH II and 17 and 24% in the MISTIE III subset. Our prognostic model identified large hemorrhage volumes and low admission GCS score as main unfavorable prognostic factors for 6-month survival. The random forest classifier achieved a predictive accuracy of 78% and an area under curve (AUC)- value of 88% regarding survival at 6 months, on a test set independent of the training set. Conclusions In comparison with our surgical group, the STICH II and MISTIE III cohorts, recruited under the premise of physician equipoise, underrepresented patients with large ICHs. The cohorts in the randomized trials were therefore biased toward patients with a favorable perspective under conservative management. Initial hematoma volume and admission GCS were the main prognostic factors in our patients.

show abstract

“…Penelitian ini memperlihatkan pasien cedera kepala berat terbanyak adalah lakilaki sebesar 82,9%. Penelitian ini sesuai dengan penelitian Kadar, et al di Amerika Serikat yang menyatakan bahwa kasus cedera kepala dari tahun ke tahun menunjukkan pasien laki-laki selalu lebih banyak daripada perempuan (18) . 18 Beberapa faktor yang mungkin mempengaruhi tingginya angka kejadian cedera kepala sedang dan berat pada laki-laki yaitu aktivitas fisik dan pekerjaan pada laki-laki lebih beresiko dibandingkan perempuan (19) .…”

Section: Pembahasanunclassified

Hubungan Kadar Natrium Serum dengan Outcome Klinis pada Pasien Cedera Kepala Berat di RSUD Abdul Wahab Sjahranie Samarinda

Rivaldi¹,

Ibrahim²,

Siagian³

2020

j. ilm. manuntung sains farm. kesehat.

View full text Add to dashboard Cite

Recently, Traumatic Brain Injury (TBI) has high mortality in the world. In severe TBI, secondary brain injury can occur. ElectrSolyte disorders are the most common in secondary brain insult especially sodium disorders. It remains unclear whether hyponatremia or hypernatremia can cause worse clinical outcome in TBI patients. This study aimed to determine association between serum sodium level with clinical outcome in severe TBI patients at RSUD Abdul Wahab Sjahranie Samarinda. A cross sectional analytical study by taking samples to the patients with diagnosed severe TBI (GCS ≤ 8) which were hospitalized at RSUD Abdul Wahab Sjahranie Samarinda in the period of January-December 2018 that complied inclusion and exclusion criteria. Research variables are sodium serum level and clinical outcome that was assessed by structured interviews for Glasgow Outcome Scale (GOS). The relationship between variables was done using the Fisher's Exact test. A total of 41 severe TBI patients were administered. The characteristics of the sample were the most patients in 20s-40s (46.3%), patients were dominated by male (82.9%) and the most common CT scan characteristic were epidural hematoma (29.3%). The most of patients showed normonatremia in 25 patients (61%), 9 patients (22%) had hypernatremia and 7 patients (17.1%) had hyponatremia. The most clinical outcome on severe TBI patients were worse outcome with 70.7% while good outcome with 29.3%. Statistical result showed there's no association between serum sodium level (hyponatremia and hypernatremia) with clinical outcome in severe TBI patients with p values, 1.000 and 0.225, respectively. There's no association between serum sodium level with clinical outcome in severe TBI patients.

show abstract

Trends in demographics and outcome of patients presenting with traumatic brain injury

Cited by 6 publications

References 17 publications

Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study

Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study

Profile and Prognosis of Spontaneous Lobar Intracerebral Hemorrhage: Comparison of 6-month Survival with STICH II and the MISTIE III Lobar Hemorrhage Subset

Hubungan Kadar Natrium Serum dengan Outcome Klinis pada Pasien Cedera Kepala Berat di RSUD Abdul Wahab Sjahranie Samarinda

Contact Info

Product

Resources

About