Factors affecting the outcomes of severe traumatic brain injury patients undergoing emergency surgery
Keywords:
severe traumatic brain injury, prognostic factor, neurological outcome, mortalityAbstract
Abstract
Severe traumatic brain injury (TBI) is a significant problem and a worldwide cause of disability and death. The purpose of this study was to evaluate the factors predicting the outcomes of severe TBI and undergoing emergency surgery. This was a retrospective study that collected data from all patients with severe TBI, and received emergency surgery from January 1st, 2018 to June 30th, 2019. Stepwise logistic regression analysis was used to identify the risk factors associated with neurological outcomes and mortality. A total of 111 patients of severe TBI undergoing emergency surgery were included, 93 patients (83.78%) were discharged from hospital, and 18 patients (16.22%) died. The favorable neurological outcomes in the hospital discharge group included 20 patients (18%). The mean age of favorable and non-favorable neurological outcomes of the hospital discharge group was between 27.20 and 41.75 years old (p<0.05). The mean age of the living and dead groups was between 47.17 and 37.98 years old (p=0.08). The analysis results revealed that variables associated with favorable neurological outcomes were patients aged ≤50 years (adjusted OR = 21.81, 95% CI = 1.69-281.62), with a prehospital Glasgow Coma Scale Score (GCS) > 5 (adjusted OR = 12.93, 95% CI = 1.78-93.67). The patients referred from other hospitals had less favorable neurological outcomes than those transferred directly from the scene. (adjusted OR = 0.04, 95% CI = 0.02-0.74). The factors affecting more deaths were patients aged >50 years (adjusted OR = 35.94, 95% CI = 3.23-399.89), prehospital GCS ≤5 (adjusted OR = 15.12, 95% CI = 1.96-116.40), oxygen saturation level <94% (adjusted OR = 8.76, 95% CI = 1.01-75.79). The computed tomography(CT) results with a subdural hemorrhage and a midline shift compared with an epidural hemorrhage with a midline shift showed a less favorable neurological outcome and a greater likelihood of death. (adjusted OR = 0.08, 95% CI = 0.01-0.52 and adjusted OR = 32.99, 95% CI = 1.39-785.75). In conclusion, the factors affecting neurological outcome at hospital discharge and death were older patients, prehospital GCS, the types of patients, oxygen saturation level, and CT results.
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