Citation

Paolo G, Rosalia Z, Statistician CA, Alberto Z, Luca LF, Francesco F, Cristina A, Andrea LL, Carlo B, Camillo F, Tiziano B, Francesco B. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Research Foundation Papa Giovanni XXIII hospital, Piazza OMS, 1 24127 Bergamo, Italy. Electronic address: fbiroli@asst-pg23.it.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.04.190

PMID

31048051

Abstract

BACKGROUND: Prognostic factors affecting outcome of TBI, despite their importance, are still under discussion. The purpose of this study was to describe risk factors of in-hospital mortality and outcome at 1-year in a homogeneously treated population of moderate/ severe TBI patients.

METHODS: A total of 193 consecutive moderate or severe TBI patients (GCS, Glasgow Coma Scale score from 13 to 3, including patients with initial GCS of 13 at high-risk for subsequent neurological deterioration), admitted to ICU, were retrospectively analyzed. In-hospital mortality and unfavorable outcome at 1-year, based on a Glasgow Outcome Score Extended (GOSE) ≤4, were considered as primary and secondary outcome.

RESULTS: At 1-year, unfavorable outcome occurred in 47.2%, including an in-hospital mortality of 19.7%. Increasing-age, GCS motor score <3, coagulation disorders and intracranial hypertension resulted as acute risk factors of in-hospital mortality. In the 155 remaining survivors: Oxford Handicap Scale (OHS), post-traumatic cerebral infarction (PTCI), cerebrospinal fluid disturbances and length of ICU-stay were associated with unfavorable outcome at 1-year, in univariate analysis. A cut-off ≥3 OHS discriminated the probability of an unfavorable outcome (AUC=0.87, p<0.001; Specificity 74% and Sensitivity 84%). Combining the effect of acute and subacute variables in a multivariate analysis, increasing-age and OHS resulted as independent predictors of outcome.

CONCLUSIONS: The results of this retrospective study confirmed age as the main acute risk factor and identified OHS as new potential subacute predictor of unfavorable outcome in moderate and severe TBI.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Oxford Handicap Scale (OHS); increasing age; moderate and severe TBI; outcome predictive factors (acute and subacute)