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Citation |
Bonow RH, Barber J, Temkin NR, Videtta W, Rondina C, Petroni G, Lujan S, Alanis V, La Fuente G, Lavadenz A, Merida R, Jibaja M, Gonzáles L, Falcao A, Romero R, Dikmen S, Pridgeon J, Chesnut RM. World Neurosurg. 2018; 111: e82-e90. |
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Affiliation |
Department of Neurological Surgery, University of Washington, Seattle, USA. |
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Copyright |
(Copyright © 2018, Elsevier Publishing) |
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DOI |
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PMID |
29229352 |
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Abstract |
Traumatic brain injury (TBI) disproportionately affects lower and middle income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries (HIC). This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥ 13 years and admitted to study hospitals with GCS ≤ 8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) at six months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. 550 patients were identified. Six month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E of 5-8. In multivariable proportional odds modeling, higher GCS motor (OR 1.41 per point, 95% CI 1.23-1.61) and epidural hematoma (OR 1.83, 95% CI 1.17-2.86) were significant predictors of higher GOS-E, whereas advanced age (OR 0.65 per 10 years, 95% CI 0.57-0.73) and cisternal effacement (P <.001) were associated with lower GOS-E. Notably, study site (P <.001) and race (P =.004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary exam. Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to HIC. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations. Language: en |
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Keywords |
Global health; Social determinants of health; Traumatic brain injury |