P.184 Off-road vehicle fatalities and alcohol in patients with major
                        traumatic brain injury: the risk of impaired driving

Background: Intoxicated patients injured in off road vehicle (ORV) crashes have higher rates of traumatic brain injury (TBI) and intensive care unit (ICU) admission, as well as prolonged ICU length of stay. This study evaluated the impact of alcohol intoxication on mortality among major TBI patients injured in off-road vehicle crashes. Methods: A retrospective analysis (2002-2014) of off-road vehicle injuries in Nova Scotia resulting in major TBI was performed. ORVs included ATVs, snowmobiles, and dirt bikes. A logistic regression model was constructed to test for in-hospital mortality and adjusted for age, Abbreviated Injury Scale (AIS) Head, Injury Severity Score, and blood alcohol concentration (BAC). Results: There were 176 drivers and passengers of off-road vehicles. Overall mortality was 28%. BAC testing was performed in 61% patients; 85% of pre-hospital deaths were BAC positive (mean BAC=31 ± 17.39 mmol/L) and 70% in-hospital deaths were BAC positive (mean BAC=26 ± 23.12 mmol/L). After adjusting for confounders, high injury severity and intoxication increased the likelihood of in-hospital mortality. Conclusions: These findings demonstrate that alcohol intoxication is a significant risk factor for mortality among off-road vehicle collisions; for every mmol/L change in BAC, there was a 10% increase in the chance of in-hospital mortality.

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Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2015/672639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hasan M. Al-Dorzi ◽

Waleed Al-Humaid ◽

Hani M. Tamim ◽

Samir Haddad ◽

Ahmad Aljabbary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Transfusion ◽

Hospital Mortality ◽

Injury Severity ◽

Tertiary Care ◽

Hemoglobin Level ◽

Secondary Insult ◽

The Impact ◽

Present On Admission

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes.Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients.Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%,p<0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients,p=0.01) and PRBC transfusion (38% versus 9% for nontransfused patients,p=0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3).Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality.

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Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings

Journal of Neurosurgery ◽

10.3171/2014.9.jns14322 ◽

2015 ◽

Vol 122 (1) ◽

pp. 211-218 ◽

Cited By ~ 28

Author(s):

Nils Petter Rundhaug ◽

Kent Gøran Moen ◽

Toril Skandsen ◽

Kari Schirmer-Mikalsen ◽

Stine B. Lund ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Severity ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Dependent Manner ◽

Blood Alcohol ◽

Severe Tbi ◽

Gcs Score ◽

Dose Dependent

OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16–70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1–3 and 4–6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4–10) than in the alcohol-negative patients (9, IQR 6–13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4–5.0) and 3.2 (range 1.5–6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1–3: OR 3.1 (range 1.4–6.6) and 6.7 (range 2.7–16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4–6 (p = 0.14–0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1–3. In patients with Rotterdam CT scores of 4–6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

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The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury

Brain Injury ◽

10.3109/02699052.2015.1075154 ◽

2015 ◽

Vol 29 (13-14) ◽

pp. 1648-1653 ◽

Cited By ~ 7

Author(s):

Pål Rønning ◽

Per Ole Gunstad ◽

Nils-Oddvar Skaga ◽

Iver Arne Langmoen ◽

Knut Stavem ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Injury Severity ◽

Ethanol Concentration ◽

Blood Ethanol Concentration ◽

The Impact ◽

Head Injury Severity

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The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

World Journal of Surgery ◽

10.1007/s00268-020-05750-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4106-4117

Author(s):

David Rösli ◽

Beat Schnüriger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Meta Analysis ◽

Accidental Hypothermia ◽

Trauma Patients ◽

Qualitative Synthesis ◽

Pubmed Database ◽

The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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Early versus Late Tracheostomy: Is There an Outcome Difference?

The American Surgeon ◽

10.1177/000313481908500427 ◽

2019 ◽

Vol 85 (4) ◽

pp. 370-375 ◽

Cited By ~ 7

Author(s):

Adel Elkbuli ◽

Raed Ismail Narvel ◽

Paul J. Spano ◽

Valerie Polcz ◽

Astrid Casin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Primary Outcome ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Early Tracheostomy ◽

Outcome Difference ◽

The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

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Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: a nationwide, population-based study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.111 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S21-S21

Author(s):

T Fu ◽

R Jing ◽

S McFaull ◽

M Cusimano

Keyword(s):

Traumatic Brain Injury ◽

Young Adults ◽

Brain Injury ◽

Hospital Mortality ◽

Injury Severity ◽

Motor Vehicle ◽

Population Based ◽

Hospital Length Of Stay ◽

Elderly Adults ◽

Hospitalization Rates

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide. We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2010 using a population-based database that is mandatory for all hospitals in Canada. Methods: Trends in hospitalization rates were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Hospitalization rates remained stable for children and young adults, but increased considerably among elderly adults (ages 65 and older). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p=0.01), while MVC-related hospitalization rates decreased by 18% (p=0.03). Elderly adults were most vulnerable to falls, and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages 15-24) were most at risk for MVCs, but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends towards increasing age, injury severity, comorbidity, hospital length of stay, and in-hospital mortality. However, multivariate regression showed that the odds of death decreased over time after controlling for relevant factors. Conclusions: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities.

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Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01544-5 ◽

2020 ◽

Author(s):

Marius Marc-Daniel Mader ◽

Rolf Lefering ◽

Manfred Westphal ◽

Marc Maegele ◽

Patrick Czorlich

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Injury Severity ◽

Cohort Analysis ◽

Independent Effect ◽

Trauma Patients ◽

Confounding Factors ◽

Retrospective Cohort Analysis ◽

Effect Of Splenectomy

Abstract Purpose Based on the hypothesis that systemic inflammation contributes to secondary injury after initial traumatic brain injury (TBI), this study aims to describe the effect of splenectomy on mortality in trauma patients with TBI and splenic injury. Methods A retrospective cohort analysis of patients prospectively registered into the TraumaRegister DGU® (TR-DGU) with TBI (AISHead ≥ 3) combined with injury to the spleen (AISSpleen ≥ 1) was conducted. Multivariable logistic regression modeling was performed to adjust for confounding factors and to assess the independent effect of splenectomy on in-hospital mortality. Results The cohort consisted of 1114 patients out of which 328 (29.4%) had undergone early splenectomy. Patients with splenectomy demonstrated a higher Injury Severity Score (median: 34 vs. 44, p < 0.001) and lower Glasgow Coma Scale (median: 9 vs. 7, p = 0.014) upon admission. Splenectomized patients were more frequently hypotensive upon admission (19.8% vs. 38.0%, p < 0.001) and in need for blood transfusion (30.3% vs. 61.0%, p < 0.001). The mortality was 20.7% in the splenectomy group and 10.3% in the remaining cohort. After adjustment for confounding factors, early splenectomy was not found to exert a significant effect on in-hospital mortality (OR 1.29 (0.67–2.50), p = 0.45). Conclusion Trauma patients with TBI and spleen injury undergoing splenectomy demonstrate a more severe injury pattern, more compromised hemodynamic status and higher in-hospital mortality than patients without splenectomy. Adjustment for confounding factors reveals that the splenectomy procedure itself is not independently associated with survival.

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Behavioural Profiles and Injury Severity Following Childhood Traumatic Brain Injury

Brain Impairment ◽

10.1375/brim.8.1.22 ◽

2007 ◽

Vol 8 (1) ◽

pp. 22-30 ◽

Cited By ~ 14

Author(s):

Suzanne L. Barker-Collo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Child Behavior Checklist ◽

Injury Severity ◽

Attention Problems ◽

Normal Limits ◽

Orthopaedic Injury ◽

Severe Tbi ◽

The Impact

AbstractTraumatic brain injury (TBI) is a leading cause of death and morbidity in children and can result in cognitive, behavioural, social and emotional difficulties that may impact quality of life. This study examined the impact of mild, moderate, and severe childhood TBI, when compared to severe orthopaedic injury, on behaviour as measured by the Child Behavior Checklist (CBCL) in a sample of 74 children with TBI and 13 with orthopaedic injury aged 4 to 13 years at the time of injury. Correlational analyses revealed that within the TBI sample increased anxiety/depression and somatisation were related to increased age at the time of injury and shorter inpatient hospital stay. Increased age was also related to increased parental reports of attention problems; while increased hospital stay was related to increased withdrawal and thought problems. Symptomatology was within normal limits for all groups, approaching the borderline clinical range in the moderate TBI group for somatic symptoms and in the severe TBI group for thought and attention problems. Those with severe TBI had more thought and attention problems, and to a lesser extent social problems, than those with mild or moderate TBI; while those with moderate TBI had the highest levels of somatic and anxious–depressed symptoms. The only scale where performance seemed to increase in relation to injury severity was the attention problems scale. It is suggested that the findings for those with moderate TBI reflect increased awareness of one's own vulnerability/mortality, with the implication that issues such as grief, loss, and mortality may need to be addressed therapeutically.

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The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

Frontiers in Neurology ◽

10.3389/fneur.2020.597737 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jelmer-Joost Lenstra ◽

Lidija Kuznecova-Keppel Hesselink ◽

Sacha la Bastide-van Gemert ◽

Bram Jacobs ◽

Maarten Willem Nicolaas Nijsten ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Cardiac Arrhythmias ◽

Injury Severity ◽

Thoracic Injury ◽

Diffuse Brain Injury ◽

Severe Tbi ◽

Ecg Abnormalities ◽

Diffuse Brain

The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.

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