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Final outcome trends in severe traumatic brain injury: a 25-year analysis of single center data

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

Evidence from the last 25 years indicates a modest reduction of mortality after severe traumatic head injury (sTBI). This study evaluates the variation over time of the whole Glasgow Outcome Scale (GOS) throughout those years.

Methods

The study is an observational cohort study of adults (≥ 15 years old) with closed sTBI (GCS ≤ 8) who were admitted within 48 h after injury. The final outcome was the 1-year GOS, which was divided as follows: (1) dead/vegetative, (2) severely disabled (dependent patients), and (3) good/moderate recovery (independent patients). Patients were treated uniformly according to international protocols in a dedicated ICU. We considered patient characteristics that were previously identified as important predictors and could be determined easily and reliably. The admission years were divided into three intervals (1987–1995, 1996–2004, and 2005–2012), and the following individual CT characteristics were noted: the presence of traumatic subarachnoid or intraventricular hemorrhage (tSAH, IVH), midline shift, cisternal status, and the volume of mass lesions (A × B × C/2). Ordinal logistic regression was performed to estimate associations between predictors and outcomes. The patients’ estimated propensity scores were included as an independent variable in the ordinal logistic regression model (TWANG R package).

Findings

The variables associated with the outcome were age, pupils, motor score, deterioration, shock, hypoxia, cistern status, IVH, tSAH, and epidural volume. When adjusting for those variables and the propensity score, we found a reduction in mortality from 55% (1987–1995) to 38% (2005–2012), but we discovered an increase in dependent patients from 10 to 21% and just a modest increase in independent patients of 6%.

Conclusions

This study covers 25 years of management of sTBI in a single neurosurgical center. The prognostic factors are similar to those in the literature. The improvement in mortality does not translate to better quality of life.

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Funding sources

This research was jointly funded by the ISCIII and FEDER European institutions, with FIS project number PI14/0157. The sponsor had no role in the design or conduct of this research.

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Correspondence to Ana M. Castaño Leon.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Investigation Ethical Committee number 16/153) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Gómez, P.A., Castaño Leon, A.M., Lora, D. et al. Final outcome trends in severe traumatic brain injury: a 25-year analysis of single center data. Acta Neurochir 160, 2291–2302 (2018). https://doi.org/10.1007/s00701-018-3705-7

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  • DOI: https://doi.org/10.1007/s00701-018-3705-7

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