Citation

Crawford AM, Yang S, Hu P, Li Y, Lozanova P, Scalea TM, Stein DM. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

R Adams Cowley Shock Trauma Center, Baltimore, MD 22 S. Greene Street Baltimore, Maryland 21201.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002256

PMID

30882765

Abstract

INTRODUCTION: Clinical data is lacking on the influence of chest trauma on the secondary injury process after TBI, with some data suggesting multi-trauma may worsens brain injury. Blunt chest trauma and TBI represent the two major single injury entities with the highest risk of complications and are potential biomarker targets.

METHODS: Trauma patients with severe TBI were enrolled. Serum biomarker levels were obtained every 6 hours for 72 hours. Baseline, 6 and 24 hours CT head scans were evaluated. Neurological worsening (NW) was defined as increased contusions, ischemia, compression of basal cisterns and/or midline shift. TBI patients with chest injury (Abbreviated Injury Scale (AIS) chest score ≥ 1) and those without chest injury were compared. Wilcoxon rank sum test, univariate logistic regression and Receiver Operating Characteristic (ROC) were reported.

RESULTS: Fifty-seven patients. Mean age 40.5 years. Median motor Glasgow Coma Scale (GSC) score at admission and 24 hours was 3 (Interquartile range [IQR] 1 to 5) and 5 (IQR 3 to 5). Of the patients enrolled, 12.2% patients underwent craniotomy within 6 hours from the time of admission and 22.8% within 12 hours. Patients with chest trauma, 24.5% had a chest AIS score ≥ 3 and 73.6% sustained blunt chest trauma. Stratifying TBI patients with and without chest injury revealed higher mean levels of IL-4, IL-5, IL-8, and IL-10 and lower mean IFN-γ and IL-7 levels in patient with chest injury. IL-7 levels adjusted for chest injury predicted neurological worsening with AUROC of 0.59 (p-value = 0.011). TBI and chest trauma patients IL-4 and NSE levels were predictive of mortality (AUROC of 0.67 and 0.63, p-value = 0.0001, 0.003) respectfully.

CONCLUSION: Utilizing biomarkers for early identification of patients with TBI and chest trauma has the capability of modifying adverse factors affecting morbidity and mortality in this subset of TBI patients.

Language: en