Clinical Significance of Vascular Occlusive Events following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

AbstractPreventing hemorrhage progression is a potential therapeutic opportunity in traumatic brain injury (TBI) management, but its use has been limited by fear of provoking vascular occlusive events (VOEs). However, it is currently unclear whether VOE actually affects outcome in these patients. The aim of this study was to determine incidence, risk factors, and clinical significance of VOE in patients with moderate-to-severe TBI. A retrospective observational cohort study of adults (≥15 years) with moderate-to-severe TBI was performed. The presence of a VOE during hospitalization was noted from hospital charts and radiological reports. Functional outcome, using the Glasgow Outcome Scale (GOS), was assessed at 12 months posttrauma. Univariate and multivariate logistic regressions were used for endpoint assessment. In total, 848 patients were included, with a median admission Glasgow Coma Scale of 7. A VOE was detected in 54 (6.4%) patients, of which cerebral venous thrombosis was the most common (3.2%), followed by pulmonary embolism (1.7%) and deep vein thrombosis (1.3%). Length of ICU stay (p < 0.001), body weight (p = 0.002), and skull fracture (p = 0.004) were independent predictors of VOE. VOE development did not significantly impact 12-month GOS, even after adjusting for potential confounders using propensity score matching. In conclusion, VOE in moderate-to-severe TBI patients was relatively uncommon, and did not affect 12-month GOS. This suggests that the potential benefit of treating bleeding progression might outweigh the risks of VOE.

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Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study

The Lancet Psychiatry ◽

10.1016/s2215-0366(18)30065-8 ◽

2018 ◽

Vol 5 (5) ◽

pp. 424-431 ◽

Cited By ~ 78

Author(s):

Jesse R Fann ◽

Anette Riisgaard Ribe ◽

Henrik Schou Pedersen ◽

Morten Fenger-Grøn ◽

Jakob Christensen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Population Based ◽

Observational Cohort Study ◽

Observational Cohort

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Prospective observational cohort study on epidemiology, treatment and outcome of patients with traumatic brain injury (TBI) in German BG hospitals

BMJ Open ◽

10.1136/bmjopen-2020-045771 ◽

2021 ◽

Vol 11 (6) ◽

pp. e045771

Author(s):

Peter Schwenkreis ◽

Andreas Gonschorek ◽

Florian Berg ◽

Ullrich Meier ◽

Witold Rogge ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Large Scale ◽

Telephone Interview ◽

Observational Cohort Study ◽

X Rays ◽

Mild Tbi ◽

Initial Care ◽

Observational Cohort

ObjectivesSince 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI.DesignObservational cohort study.SettingAll patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included.ParticipantsIn total, 3514 patients were included.Outcome measuresInitial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome.ResultsPeaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14.ConclusionThe observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis ‘mild TBI’ emphasises the need for defining subgroups not only based on GCS.

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Clinical Impact of Hemorrhagic Lesion Progression Following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

10.21203/rs.3.rs-570495/v1 ◽

2021 ◽

Author(s):

Alexander Fletcher-Sandersjöö ◽

Charles Tatter ◽

Jonathan Tjerkaski ◽

Jiri Bartek ◽

Marc Maegele ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Regression Analysis ◽

Cohort Study ◽

Brain Injury ◽

Ct Scan ◽

Intracranial Hemorrhage ◽

Observational Cohort Study ◽

Traumatic Intracranial Hemorrhage ◽

Observational Cohort ◽

The Mean

Abstract Background Hemorrhage progression following traumatic brain injury (TBI) is not fully understood, and preventing it would be a potential therapeutic opportunity in TBI management. The aim of this study was to determine how non-operated hemorrhagic lesions progress following TBI, and how this affects outcome. Methods This was a retrospective observational cohort study of adult patients (≥ 15 years) with moderate-to-severe TBI. Hemorrhage volumes were calculated from computed tomography (CT) scans using semi-automated volumetric segmentation. Results In total, 643 patients were included, with a median Glasgow Coma Scale of 7. Contusions were the most common form of traumatic intracranial hemorrhage. The mean total lesion volume on the first CT scan was 4.29 ml, and the mean lesion progression volume (LPV), i.e. the increase in volume from first CT scan until the lesion had stopped progressing, was 3.85 ml. Contusions showed a significantly larger LPV than SDH and EDH (p < 0.001). The median lesion progression time (LPT), i.e. the time from injury until all lesions had stopped progressing, was 5.98 hours, with contusions progressing for a longer time than tSAH, SDH and EDH (p < 0.001). Hemorrhage progression also slowed exponentially over time, with almost no further expansion occurring 24 hours after trauma. In multivariable regression analysis, LPV was independently associated with 12-month Glasgow Outcome Score after adjusting for known TBI outcome predictors (p < 0.001). Conclusions Contusions were the most common form of traumatic intracranial hemorrhage, and exhibited both a larger LPV and longer LPT than extra-axial hematomas. Regression analysis indicated that LPV was independently related to, and possibly a driver of, unfavorable outcome. Interventions to prevent lesion progression are therefore likely to improve outcome in TBI patients. Moreover, this study suggests a wider window of opportunity to prevent lesion progression than what has previously been suggested.

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