Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis

Abstract BackgroundPharmacological elevation of blood pressure is frequently incorporated in severe traumatic brain injury management algorithms. However, there is limited evidence on prevalent clinical practices regarding resuscitation for severe traumatic brain injury using vasopressors. We conducted a nationwide retrospective cohort study to determine the association between the use of vasopressors and mortality following hospital discharge in patients with severe traumatic brain injury, and to determine whether the use of vasopressors affects emergency department mortality or the occurrence of cognitive dysfunction.MethodsData were collected between January 2004 and December 2018 from the Japanese Trauma Data Bank, which includes data from 272 emergency hospitals in Japan. Adults aged ≥16 years with severe traumatic brain injury, without other major injuries, were examined. A severe traumatic brain injury was defined based on the Abbreviated Injury Scale code and a Glasgow Coma Scale score of 3–8 on admission. Multivariable analysis and propensity score matching were performed. Statistical significance was assessed using 95% confidence intervals (CIs).ResultsIn total, 10 284 patients were eligible for analysis, with 650 patients (6.32%) included in the vasopressor group and 9634 patients (93.68%) included in the non-vasopressor group. The proportion of deaths on hospital discharge was higher in the vasopressor group than in the non-vasopressor group (81.69% [531/650] vs. 40.21% [3,874/9,634]). This finding was confirmed by multivariable logistic regression analysis (adjusted odds ratio [OR], 5.71; 95% CI: 4.56–7.16). Regarding propensity score-matched patients, the proportion of deaths on hospital discharge remained higher in the vasopressor group than in the non-vasopressor group (81.66% [530/649] vs. 50.69% [329/649]) (OR, 4.33; 95% CI: 3.37–5.57). The vasopressor group had a higher emergency department mortality rate than the non-vasopressor group (8.01% [52/649] vs. 2.77% [18/649]) (OR, 3.05; 95% CI: 1.77–5.28). There was no reduction in complications of cognitive disorders in the vasopressor group (5.39% [35/649] vs. 5.55% [36/649]) (OR, 0.97; 95% CI: 0.60–1.57).ConclusionsIn this population, the use of vasopressors for severe traumatic brain injury was associated with higher mortality on hospital discharge. Our results suggest that vasopressors should be avoided in most cases of severe traumatic brain injury.

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Monitoring Recovery of Cognitive Function Following Severe Traumatic Brain Injury

Brain Impairment ◽

10.1375/brim.2.1.22 ◽

2001 ◽

Vol 2 (1) ◽

pp. 22-28 ◽

Cited By ~ 3

Author(s):

Barbara A. Wilson ◽

Agnes Shiel ◽

Lindsay McLellan ◽

Sandra Horn ◽

Martin A. Watson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Severe Traumatic Brain Injury ◽

Assessment Tool ◽

Motor Functioning ◽

Case Examples ◽

Traumatic Amnesia ◽

Severe Tbi ◽

Minimally Conscious

AbstractWe report on the development of a new assessment tool to monitor recovery after severe traumatic brain injury (TBI). Although a number of scales exist to identify such recovery, most are limited if one is interested in monitoring small changes or in setting goals for rehabilitation. This is due to the fact that items are too broad, they may cross more than one dimension (e.g. cognition and motor functioning) and there is a danger that recording of responses may be too subjective. The Wessex Head Injury Matrix (WHIM) was developed to avoid these problems. We observed 88 people with severe TBI. These were consecutive admissions to two hospitals. Mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Of 145 behaviours observed, we selected 62 and each behaviour was compared to every other behaviour to determine a likely order of recovery. The resulting WHIM is an observational tool to assess and monitor cognitive recovery after severe head injury. It can be used with patients who are in coma, just out of coma or who are minimally conscious. Two case examples are provided.

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Early enteral nutrition in patients with severe traumatic brain injury: a propensity score–matched analysis using a nationwide inpatient database in Japan

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz290 ◽

2019 ◽

Vol 111 (2) ◽

pp. 378-384 ◽

Cited By ~ 1

Author(s):

Hiroyuki Ohbe ◽

Taisuke Jo ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Hideo Yasunaga

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Enteral Nutrition ◽

Hospital Mortality ◽

Nosocomial Pneumonia ◽

Severe Traumatic Brain Injury ◽

Scale Scores ◽

Severe Tbi ◽

Inpatient Database

ABSTRACT Background Whether enteral nutrition (EN) should be administered early in severe traumatic brain injury (TBI) patients has not been fully addressed. Objective The present study aimed to evaluate whether early EN can reduce mortality or nosocomial pneumonia among severe TBI patients. Methods Using the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017 linked with the Survey for Medical Institutions, we identified patients admitted for intracranial injury with Japan Coma Scale scores ≥30 (corresponding to Glasgow Coma Scale scores ≤8) at admission. We designated patients who started EN within 2 d of admission as the early EN group, and those who started EN at 3–5 d after admission as the delayed EN group. The primary outcome was in-hospital mortality. The secondary outcome was nosocomial pneumonia. Propensity score–matched analyses were performed to compare the outcomes between the 2 groups. Results We identified 3080 eligible patients during the 36-mo study period, comprising 1100 (36%) in the early EN group and 1980 (64%) in the delayed EN group. After propensity score matching, there was no significant difference in in-hospital mortality (difference: −0.3%; 95% CI: −3.7%, 3.1%) between the 2 groups. The proportion of nosocomial pneumonia was significantly lower in the early EN group than in the delayed EN group (difference: −3.2%; 95% CI: −5.9%, −0.4%). Conclusions Early EN may not reduce mortality, but may reduce nosocomial pneumonia in patients with severe TBI.

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Stress-Induced Hyperglycemia, but Not Diabetic Hyperglycemia, Is Associated with Higher Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph14111340 ◽

2017 ◽

Vol 14 (11) ◽

pp. 1340 ◽

Cited By ~ 12

Author(s):

Cheng-Shyuan Rau ◽

Shao-Chun Wu ◽

Yi-Chun Chen ◽

Peng-Chen Chien ◽

Hsiao-Yun Hsieh ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Severe Traumatic Brain Injury ◽

Injury Analysis

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489: INDIRECT CALORIMETRY: A MORE SUITABLE NUTRITIONAL ASSESSMENT TOOL IN SEVERE TRAUMATIC BRAIN INJURY

Critical Care Medicine ◽

10.1097/01.ccm.0000620300.49567.c5 ◽

2020 ◽

Vol 48 (1) ◽

pp. 225-225

Author(s):

Sonia Wu ◽

Sameena Iqbal ◽

Norine Alam ◽

Tarek Razek ◽

Dan Deckelbaum ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Indirect Calorimetry ◽

Assessment Tool ◽

Nutritional Assessment

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A Propensity Score Analysis of the Impact of Invasive Intracranial Pressure Monitoring on Outcomes after Severe Traumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2015.4015 ◽

2016 ◽

Vol 33 (9) ◽

pp. 853-858 ◽

Cited By ~ 18

Author(s):

Deepak Agrawal ◽

Krishnan Raghavendran ◽

Douglas E. Schaubel ◽

Mahesh C. Mishra ◽

Venkatakrishna Rajajee

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Propensity Score ◽

Severe Traumatic Brain Injury ◽

Propensity Score Analysis ◽

Intracranial Pressure Monitoring ◽

Pressure Monitoring ◽

Score Analysis ◽

The Impact

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Use of Vasopressors Increases the Risk of Mortality in Severe Traumatic Brain Injury: A Nationwide Retrospective Cohort Study in Japan

10.21203/rs.3.rs-140000/v1 ◽

2021 ◽

Author(s):

Sanae Hosomi ◽

Tomotaka Sobue ◽

Tetsuhisa Kitamura ◽

Atsushi Hirayama ◽

Hiroshi Ogura ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Cohort Study ◽

Brain Injury ◽

Propensity Score ◽

Hospital Discharge ◽

Severe Traumatic Brain Injury ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Tbi

Abstract Background: Pharmacological elevation of blood pressure is frequently incorporated in severe traumatic brain injury (TBI) management algorithms. However, there is limited evidence on prevalent clinical practices regarding resuscitation for severe TBI using vasopressors. We conducted a nationwide retrospective cohort study to determine the association between the use of vasopressors and mortality following discharge from hospital in patients with severe TBI, and to determine whether the use of vasopressors affects emergency department mortality or the occurrence of cognitive dysfunction.Methods: Data were collected between January 2004 and December 2018 by the Japanese Trauma Data Bank, which includes data from 272 emergency hospitals in Japan. Adults aged ≥ 16 years with severe TBI, without other major injuries, were examined. A severe TBI was defined based on the Abbreviated Injury Scale code and a Glasgow Coma Scale score of 3–8 on admission. Multivariable and propensity score matching analyses were performed. Statistical significance was assessed using a 95% CI.Results: In total, 10,284 patients were eligible for analysis, with 650 patients (6.32%) included in the vasopressor group and 9,634 patients (93.68%) included in the non-vasopressor group. The proportion of deaths on hospital discharge was higher in the vasopressor group than in the non-vasopressor group (81.69% [531/650] vs. 40.21% [3,874/9,634]). This finding was confirmed by multivariable logistic regression analysis (adjusted odds ratio [OR], 5.71; 95% confidence interval [CI]: 4.56–7.16). Regarding propensity score-matched patients, the proportion of deaths on hospital discharge remained higher in the vasopressor group than in the non-vasopressor group (81.66% [530/649] vs. 50.69% [329/649]) (OR, 4.33; 95% CI: 3.37–5.57). The vasopressor group had a higher emergency department mortality rate than the non-vasopressor group (8.01% [52/649] vs. 2.77% [18/649]) (OR, 3.05; 95% CI: 1.77–5.28). There was no reduction in complications of cognitive disorders in the vasopressor group (5.39% [35/649] vs. 5.55% [36/649]) (OR, 0.97; 95% CI: 0.60–1.57).Conclusions: In this population, the use of vasopressors for severe TBI was associated with higher mortality on hospital discharge. Our results suggest that vasopressors should be avoided in most cases of severe TBI.

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