Background: Secondary insults (SI), such as hypotension, hypoxia, and intracranial hypertension frequently occur after traumatic brain injury (TBI), and have a strong impact on patients’ clinical outcomes. The aim of this study is to examine the trajectories of SI from the early phase of injury in the prehospital setting to hospital admission in a cohort of TBI patients. Methods: This is a retrospective, observational, single centre study on consecutive patients admitted from 1997 to 2016 to the Neuro Intensive Care Unit (NICU) at San Gerardo Hospital, in Monza, Italy. Trajectories of SI from the prehospital to hospital settings were defined as “sustained”, “resolved”, “new event”, and “none”. Univariate and multivariate logistic regression analyses were performed to correlate SI trajectories to a 6-months outcome. Results: Nine hundred sixty-seven patients were enrolled in the final analysis. About 20% had hypoxic or hypotensive events and 30.7% of patients had pupillary abnormalities. Hypotension and hypoxia were associated with an unfavourable outcome when “sustained” and “resolved”, while pupillary abnormalities were associated with a poor outcome when “sustained” and as “new events”. After adjusting for confounding factors, 6-month mortality strongly correlated with “sustained” hypotension (OR 11.25, 95% CI, 3.52–35.99), “sustained” pupillary abnormalities (OR 2.8, 95% CI, 1.51–5.2) and “new event” pupillary abnormalities (OR 2.8, 95% CI, 1.16–6.76). Conclusions: After TBI, sustained hypotension and pupillary abnormalities are important determinants for patients’ outcomes. Early trajectories define the dynamics of SI and contribute to a better understanding of how early recognition and treatments in emergency settings could impact on 6-month outcomes and mortality.

Trajectories of early secondary insults correlate to outcomes of traumatic brain injury: results from a large, single centre, observational study / P.C. Volpi, C. Robba, M. Rota, A. Vargiolu, G. Citerio. - In: BMC EMERGENCY MEDICINE. - ISSN 1471-227X. - 18:1(2018 Dec 05), pp. 52.1-52.9. [10.1186/s12873-018-0197-y]

Trajectories of early secondary insults correlate to outcomes of traumatic brain injury: results from a large, single centre, observational study

M. Rota;
2018-12-05

Abstract

Background: Secondary insults (SI), such as hypotension, hypoxia, and intracranial hypertension frequently occur after traumatic brain injury (TBI), and have a strong impact on patients’ clinical outcomes. The aim of this study is to examine the trajectories of SI from the early phase of injury in the prehospital setting to hospital admission in a cohort of TBI patients. Methods: This is a retrospective, observational, single centre study on consecutive patients admitted from 1997 to 2016 to the Neuro Intensive Care Unit (NICU) at San Gerardo Hospital, in Monza, Italy. Trajectories of SI from the prehospital to hospital settings were defined as “sustained”, “resolved”, “new event”, and “none”. Univariate and multivariate logistic regression analyses were performed to correlate SI trajectories to a 6-months outcome. Results: Nine hundred sixty-seven patients were enrolled in the final analysis. About 20% had hypoxic or hypotensive events and 30.7% of patients had pupillary abnormalities. Hypotension and hypoxia were associated with an unfavourable outcome when “sustained” and “resolved”, while pupillary abnormalities were associated with a poor outcome when “sustained” and as “new events”. After adjusting for confounding factors, 6-month mortality strongly correlated with “sustained” hypotension (OR 11.25, 95% CI, 3.52–35.99), “sustained” pupillary abnormalities (OR 2.8, 95% CI, 1.51–5.2) and “new event” pupillary abnormalities (OR 2.8, 95% CI, 1.16–6.76). Conclusions: After TBI, sustained hypotension and pupillary abnormalities are important determinants for patients’ outcomes. Early trajectories define the dynamics of SI and contribute to a better understanding of how early recognition and treatments in emergency settings could impact on 6-month outcomes and mortality.
Outcome; Prehospital insults; Secondary injuries; Trajectory; Traumatic brain injury
Settore MED/41 - Anestesiologia
Settore MED/01 - Statistica Medica
Article (author)
File in questo prodotto:
File Dimensione Formato  
Volpi et al BMC Emergency Medicine 2018 18 52.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 698.83 kB
Formato Adobe PDF
698.83 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/606410
Citazioni
  • ???jsp.display-item.citation.pmc??? 10
  • Scopus 19
  • ???jsp.display-item.citation.isi??? 16
social impact