Intensive Care Admission Variables May Predict Outcome Following Severe Traumatic Brain Injury: A Prospective Observational Study

Author(s): Rabiu MB, Eguma S, Abdullahi AA

Background: Severe traumatic brain injury (STBI) is a significant health concern and a major social and financial burden for society. It is a leading cause of death in both developed and developing countries. Outcome prediction following severe traumatic brain injury is of great clinical and economic importance especially in developing countries, where health resources are limited. This study aimed at predicting outcome among patients with severe traumatic brain injury using selected admission.

Patients and Method: Following institutional ethic committee approval, forty consecutive patients admitted into ICU were enrolled in the study, after consent was obtained from patient relations. Patients who were apneic, did not have CT-scan, had penetrating head trauma or severe extra cranial injury were excluded from the study. Demographic variables were age, gender, cause of injury. Intensive Care admission variables recorded were post resuscitation GCS, admission haemoglobin concentration, blood sugar level, systolic blood pressure, CT scan profile and type of brain injury. All Patients were initially mechanically ventilated using IPPV for 48 hours, thereafter patients were placed on weaning mode of either SIMV or BiPAP. Sedation was reduced for spontaneous breath trial Patient outcome was categorized into two groups: favourable outcome for those with good recovery and moderate disability and unfavourable outcome for those who died, were severely disabled and those in persistent vegetative state, using the Glasgow Outcome Scale at 14 days and 3 months follow up. The data obtained was analyzed electronically using SPSS version 20 and presented using relevant tables and figures. Descriptive statistical analysis was used to determine incidence of unfavourable outcome at 14 days and 3 months. Chi square test was used to determine the association between the selected variables and outcome. All selected variables were subjected to univariate regression to determine the predictors of outcome at 3 months, with confidence interval set at 95%. P<0.05.

Results: Fourty patients were enrolled in the study, 3 patients were not available for follow up and were removed from the study. The overall incidence of unfavourable outcome at 14 days was 100% while at 3 months post-injury it was 81.1%. Road traffic accident was the major cause of traumatic brain injury and there was a Male: Female ratio of 8:1. Hypotension (P=0.015), hyperglycemia (P=0.016), midline brain shift>5 mm (P=0.039), absent or compressed cistern (P= 0.007), heamoglobin concentration<10 g/dl (P=0.041), were significant predictors of unfavourable outcome at 3 months on univiriate regression analysis.

Conclusions: Our study revealed hypotension, hyperglycaemia, anaemia mid-line brain shift greater than 5 mm and absent or compressed cistern on brain CT-scan are statistically significant predictors of unfavourable outcome at univiriate analysis following severe traumatic brain injury at 3 months post trauma.

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