External validation of the rotterdam computed tomography score in the prediction of mortality in severe traumatic brain injury

ABSTRACT Introduction: Traumatic brain injury (TBI) is a public health problem. It is a pathology that causes significant mortality and disability in Colombia. Different calculators and prognostic models have been developed to predict the neurological outcomes of these patients. The Rotterdam computed tomography (CT) score was developed for prognostic purposes in TBI. We aimed to examine the accuracy of the prognostic discrimination and prediction of mortality of the Rotterdam CT score in a cohort of trauma patients with severe TBI in a university hospital in Colombia. Materials and Methods: We analyzed 127 patients with severe TBI treated in a regional trauma center in Colombia over a 2-year period. Bivariate and multivariate analyses were used. The discriminatory power of the score, its accuracy, and precision were assessed by logistic regression and as the area under the receiver operating characteristic curve. Shapiro–Wilk, Chi-square, and Wilcoxon tests were used to compare the real outcomes in the cohort against the predicted outcomes. Results: The median age of the patient cohort was 33 years, and 84.25% were male. The median injury severity score was 25, the median Glasgow Coma Scale motor score was 3, the basal cisterns were closed in 46.46% of the patients, and a midline shift of >5 mm was seen in 50.39%. The 6-month mortality was 29.13%, and the Rotterdam CT score predicted a mortality of 26% (P < 0.0001) (area under the curve: 0.825; 95% confidence interval: 0.745–0.903). Conclusions: The Rotterdam CT score predicted mortality at 6 months in patients with severe head trauma in a university hospital in Colombia. The Rotterdam CT score is useful for predicting early death and the prognosis of patients with TBI.

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Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study

Clinical Rehabilitation ◽

10.1177/0269215517734294 ◽

2017 ◽

Vol 32 (5) ◽

pp. 692-704 ◽

Cited By ~ 6

Author(s):

Camille Chesnel ◽

Claire Jourdan ◽

Eleonore Bayen ◽

Idir Ghout ◽

Emmanuelle Darnoux ◽

...

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Significant Relationship ◽

Injury Severity ◽

Chronic Phase ◽

Functional Independence ◽

Severe Tbi

Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.

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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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Abstract 230: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated vs. Multisystem Major Traumatic Brain Injury

Circulation ◽

10.1161/circ.138.suppl_2.230 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Daniel W Spaite ◽

Chengcheng Hu ◽

Bentley J Bobrow ◽

Bruce J Barnhart ◽

Vatsal Chikani ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Severity ◽

Treatment Effectiveness ◽

Guideline Implementation ◽

Body Region ◽

Head Region ◽

Differential Effects ◽

Severe Tbi

Background: In hospital-based studies, hypotension (HT, SBP <90) is more likely to occur in multisystem traumatic brain injury (MTBI) than isolated (ITBI). However, there are few EMS studies on this issue. Hypothesis: Prehospital HT is associated with differential effects in MTBI and ITBI and these effects are influenced by the severity of primary brain injury. Methods: Inclusion: TBI cases in the EPIC Study (NIH 1R01NS071049) before TBI guideline implementation (1/07-3/14). ITBI: Major TBI cases (CDC Barell Matrix Type 1) that had no injury with ICD9-based Regional Severity Score [RSS (AIS equivalent)] ≥3 in any other body region. MTBI: Type 1 TBI plus at least one non-head region injury with RSS ≥3. Results: Included were 13,435 cases [Excl: age <10 (5.9%), missing data (6.2%)]. 10,374 (77.2%) were ITBI, 3061 (22.8%) MTBI. Mortality: ITBI: 7.7% (797/10,374), MTBI: 19.2% (587/3061, p<0.0001). Prehospital HT occurred 3.5 times more often in MTBI (14.8%, 453/3061 vs 4.2%, 437/10,374; p<0.0001). Among HT cases, 40.8% (185/453) with MTBI died vs 30.9% with ITBI (135/437; p<0.0001). In the hypotensive moderate/severe TBI cohort (RSS-Head 3/4), MTBI mortality was 2.4 times higher (17.2%, 40/232) than ITBI (7.1%, 17/240, p = 0.001). However, in the hypotensive very/extremely severe TBI group (RSS-Head 5/6), mortality was almost identical in MTBI (73.4%, 141/192) and ITBI (72.1%, 116/161, p = 0.864). Conclusion: Among major TBI patients with prehospital HT, those with MTBI were much more likely to die than those with ITBI. However, this association varied dramatically with TBI severity. In mod/severe TBI cases with HT, MTBI mortality was 2.4 times higher than in ITBI. In contrast, in very/extremely severe TBI with HT, there was no identifiable mortality difference. Thus, in cases with substantial potential to survive the primary brain injury (mod/severe), outcome is markedly worse in patients with multisystem injuries. However, in very/extremely severe TBI, non-head region injuries have no apparent association with mortality. This may be because the TBI is the primary factor leading to death in these cases. The main EPIC study is evaluating whether this severity-based difference in “effect” has implications for TBI guideline treatment effectiveness.

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Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

Clinical Nursing Research ◽

10.1177/10547738211050489 ◽

2021 ◽

pp. 105477382110504

Author(s):

Jeong Eun Yoon ◽

Ok-Hee Cho

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Medical Records ◽

Injury Severity ◽

University Hospital ◽

Factors Associated ◽

Braden Scale

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.

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White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽

10.1212/wnl.0000000000012222 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012222

Author(s):

Emily L Dennis ◽

Karen Caeyenberghs ◽

Kristen R Hoskinson ◽

Tricia L Merkley ◽

Stacy J Suskauer ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Behavioral Problems ◽

Child Behavior Checklist ◽

Injury Severity ◽

Meta Analysis ◽

Post Injury ◽

Severe Tbi ◽

Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

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Severe Traumatic Brain Injury (TBI) Modulates the Kinetic Profile of the Inflammatory Response of Markers for Neuronal Damage

Journal of Clinical Medicine ◽

10.3390/jcm9061667 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1667 ◽

Cited By ~ 3

Author(s):

Cora Rebecca Schindler ◽

Thomas Lustenberger ◽

Mathias Woschek ◽

Philipp Störmann ◽

Dirk Henrich ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Inflammatory Response ◽

Calcium Binding ◽

Injury Severity ◽

Neuronal Damage ◽

Severe Trauma ◽

Multiple Injuries ◽

Kinetic Profile ◽

Severe Tbi

The inflammatory response plays an important role in the pathophysiology of multiple injuries. This study examines the effects of severe trauma and inflammatory response on markers of neuronal damage. A retrospective analysis of prospectively collected data in 445 trauma patients (Injury Severity Score (ISS) ≥ 16) is provided. Levels of neuronal biomarkers (calcium-binding Protein B (S100b), Enolase2 (NSE), glial fibrillary acidic protein (GFAP)) and Interleukins (IL-6, IL-10) in severely injured patients (with polytrauma (PT)) without traumatic brain injury (TBI) or with severe TBI (PT+TBI) and patients with isolated TBI (isTBI) were measured upon arrival until day 5. S100b, NSE, GFAP levels showed a time-dependent decrease in all cohorts. Their expression was higher after multiple injuries (p = 0.038) comparing isTBI. Positive correlation of marker level after concomitant TBI and isTBI (p = 0.001) was noted, while marker expression after PT appears to be independent. Highest levels of IL-6 and -10 were associated to PT und lowest to isTBI (p < 0.001). In all groups pro-inflammatory response (IL-6/-10 ratio) peaked on day 2 and at a lower level on day 4. Severe TBI modulates kinetic profile of inflammatory response by reducing interleukin expression following trauma. Potential markers for neuronal damage have a limited diagnostic value after severe trauma because undifferentiated increase.

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Quantitative EEG Parameters for Prediction of Outcome in Severe Traumatic Brain Injury: Development Study

Clinical EEG and Neuroscience ◽

10.1177/1550059417742232 ◽

2017 ◽

Vol 49 (4) ◽

pp. 248-257 ◽

Cited By ~ 16

Author(s):

Antti Tolonen ◽

Mika O. K. Särkelä ◽

Riikka S. K. Takala ◽

Ari Katila ◽

Janek Frantzén ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Value ◽

Outcome Prediction ◽

Characteristic Curve ◽

Quantitative Eeg ◽

University Hospital ◽

Alpha Power ◽

Continuous Eeg ◽

Severe Tbi

Monitoring of quantitative EEG (QEEG) parameters in the intensive care unit (ICU) can aid in the treatment of traumatic brain injury (TBI) patients by complementing visual EEG review done by an expert. We performed an explorative study investigating the prognostic value of 59 QEEG parameters in predicting the outcome of patients with severe TBI. Continuous EEG recordings were done on 28 patients with severe TBI in the ICU of Turku University Hospital. We computed a set of QEEG parameters for each patient, and correlated these to patient outcome, measured by dichotomized Glasgow Outcome Scale (GOS) at a follow-up visit between 6 and 12 months, using area under receiver operating characteristic curve (AUC) as a nonlinear correlation measure. For 17 of the 59 QEEG parameters (28.8%), the AUC differed significantly from 0.5, most of these parameters measured EEG power or variability. The best QEEG parameters for outcome prediction were alpha power (AUC = 0.87, P < .01) and variability of the relative fast theta power (AUC = 0.84, P < .01). The results of this study indicate that QEEG parameters provide useful information for predicting outcome in severe TBI. Novel QEEG parameters with potential in outcome prediction were found, the prognostic value of these parameters should be confirmed in later studies. The results also provide further evidence of the usefulness of parameters studied in preexisting studies.

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Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds1544 ◽

2016 ◽

Vol 17 (1) ◽

pp. 19-26 ◽

Cited By ~ 24

Author(s):

Thomas M. O’Lynnger ◽

Chevis N. Shannon ◽

Truc M. Le ◽

Amber Greeno ◽

Dai Chung ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Critical Care ◽

Brain Injury ◽

Pediatric Patients ◽

Injury Severity ◽

Protocol Implementation ◽

Discharge Disposition ◽

Ordered Logistic Regression ◽

Before And After ◽

Severe Tbi

OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.

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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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