Temporal changes in outcome following intensive care unit treatment after traumatic brain injury : a 17-year experience in a large academic neurosurgical centre

Show full item record



Permalink

http://hdl.handle.net/10138/273451

Citation

Lindfors , M , Vehviläinen , J , Siironen , J , Kivisaari , R , Skrifvars , M B & Raj , R 2018 , ' Temporal changes in outcome following intensive care unit treatment after traumatic brain injury : a 17-year experience in a large academic neurosurgical centre ' , Acta Neurochirurgica , vol. 160 , no. 11 , pp. 2107-2115 . https://doi.org/10.1007/s00701-018-3670-1

Title: Temporal changes in outcome following intensive care unit treatment after traumatic brain injury : a 17-year experience in a large academic neurosurgical centre
Author: Lindfors, Matias; Vehviläinen, Juho; Siironen, Jari; Kivisaari, Riku; Skrifvars, Markus B.; Raj, Rahul
Contributor: University of Helsinki, University of Helsinki
University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, Department of Neurosciences
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, HUS Neurocenter
Date: 2018-11
Language: eng
Number of pages: 9
Belongs to series: Acta Neurochirurgica
ISSN: 0001-6268
URI: http://hdl.handle.net/10138/273451
Abstract: Traumatic brain injury (TBI) is a major cause of morbidity and mortality. However, it remains undetermined whether long-term outcomes after TBI have improved over the past two decades. We conducted a retrospective analysis of consecutive TBI patients admitted to an academic neurosurgical ICU during 1999-2015. Primary outcomes of interest were 6-month all-cause mortality (available for all patients) and 6-month Glasgow Outcome Scale (GOS, available from 2005 onwards). GOS was dichotomized to favourable and unfavourable functional outcome. Temporal changes in outcome were assessed using multivariate logistic regression analysis, adjusting for age, sex, GCS motor score, pupillary light responsiveness, Marshall CT classification and major extracranial injury. Altogether, 3193 patients were included. During the study period, patient age and admission Glasgow Coma Scale score increased, while the overall TBI severity did not change. Overall unadjusted 6-month mortality was 25% and overall unadjusted unfavourable outcome (2005-2015) was 44%. There was no reduction in the adjusted odds of 6-month mortality (OR 0.98; 95% CI 0.96-1.00), but the adjusted odds of favourable functional outcome significantly increased (OR 1.08; 95% CI 1.04-1.11). Subgroup analysis showed outcome improvements only in specific subgroups (conservatively treated patients, moderate-to-severe TBI patients, middle-aged patients). During the past two decades, mortality after significant TBI has remained largely unchanged, but the odds of favourable functional outcome have increased significantly in specific subgroups, implying an improvement in quality of care. These developments have been paralleled by notable changes in patient characteristics, emphasizing the importance of continuous epidemiological monitoring.
Subject: Traumatic brain injury
Outcome
Mortality
Epidemiology
HEAD-INJURY
COMPUTERIZED-TOMOGRAPHY
TRENDS
CLASSIFICATION
MANAGEMENT
MORTALITY
EPIDEMIOLOGY
IMPROVEMENT
GUIDELINES
TRIALS
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
Lindfors2018_Ar ... ChangesInOutcomeFollow.pdf 589.1Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record