Frequency and impact of intensive care unit complications on moderate-severe traumatic brain injury: early results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study
Department of Neurology; Center for Outcomes Research; Department of Quantitative Health Sciences
Adult; Aged; Aged, 80 and over; Brain Edema; Brain Hemorrhage, Traumatic; Brain Injuries; Cohort Studies; Cross Infection; Encephalocele; Female; Fever; Glasgow Coma Scale; Hospital Mortality; Humans; Hyperglycemia; Hypotension; Injury Severity Score; *Intensive Care Units; Logistic Models; Male; Middle Aged; Multivariate Analysis; Outcome Assessment (Health Care); Prospective Studies; Recurrence; Systemic Inflammatory Response Syndrome; Urinary Tract Infections; Young Adult
Health Services Research | Nervous System Diseases | Neurology
BACKGROUND: Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes are poorly understood.
METHODS: In 213 consecutive msTBI patients admitted to a Level I Trauma Center neuro trauma ICU, twenty-eight ICU-COMPL (21 medical and 7 neurological) were prospectively collected and adjudicated by group consensus, using pre-defined criteria. We determined frequencies, and explored associations of ICU-COMPL and hospital discharge outcomes using multivariable logistic regression.
RESULTS: The average age of the study sample was 53 years, and the median presenting Glasgow Coma Scale and Injury Severity Scores were 5 and 27, respectively. Hyperglycemia (79%), fever (62%), systemic inflammatory response syndrome (60%), and hypotension requiring vasopressors (42%) were the four most common medical ICU-COMPL. Herniation (39%), intracranial rebleed (39%), and brain edema requiring osmotherapy (37%) were the three most common neurological ICU-COMPL. After adjusting for admission variables, duration of ventilation, and ICU length-of-stay, patients with brain edema (OR 5.8; 95% CI 2, 16.7) had a significantly increased odds for dying during hospitalization whereas patients with hospital-acquired urinary tract infection (UTI) had a decreased odds (OR 0.05; 95% CI 0.005, 0.6). Sensitivity analysis revealed that UTI occurred later, suggesting a non-causal association with survival. Brain herniation (OR 15.7; 95% CI 2.6, 95.4) was associated with an unfavorable functional status (GOS 1-3).
CONCLUSION: ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high risk patients. Survival associations of time-dependent complications warrant cautious interpretation.
Traumatic brain injury, Adult brain injury, Functional outcom, Intensive care unit complications, Medical complications
Muehlschlegel, Susanne; Carandang, Raphael A.; Ouillette, Cynthia; Hall, Wiley R.; Anderson, Frederick A. Jr.; and Goldberg, Robert J., "Frequency and impact of intensive care unit complications on moderate-severe traumatic brain injury: early results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study" (2013). University of Massachusetts Medical School Faculty Publications. 409.