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
DOI of Published Version
Muehlschlegel S, Carandang R, Ouillette C, Hall W, Anderson F, Goldberg R. 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. Neurocrit Care. 2013 Jun;18(3):318-31. doi:10.1007/s12028-013-9817-2.
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.