Citation

Dolmans RGF, Hulsbergen AFC, Gormley WB, Broekman MLD. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands. Electronic address: m.l.d.broekman@lumc.nl.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.10.086

PMID

31655234

Abstract

OBJECTIVE: Outcome prediction in severe traumatic brain injury (sTBI) has been studied using clinical and radiographic measurements and by using biomarkers such as GFAP, UCHL1 and tau. Routine blood tests are regularly performed in sTBI patients and could potentially be used to predict outcomes. This study aims to investigate whether routine blood tests on admission can be predictive of outcome in patients with sTBI.

METHODS: Patients with sTBI from two institutional databases were selected based on ICD 9/10 codes for TBI, ventilatory assistance >24h, intracranial pressure (ICP) monitoring and Glasgow Coma Score (GCS) <= 8. Laboratory parameters included: blood urea nitrogen, creatinine, glucose, hematocrit, hemoglobin, red blood cells, white blood cells, monocytes, lymphocytes, neutrophils, neutrophil lymphocyte ratio, platelets, INR, prothrombin time (PT), sodium and potassium. Clinical outcome was measured as hospital length of stay, 30-day mortality and favorable versus unfavorable outcome based on Glasgow Outcome Scale at 3 months.

RESULTS: 255 adult patients were selected. Median Injury Severity Score (ISS) was 14.00 [IQR: 9.00-22.00]. 25.9% of patients died within 30 days and 56.1% of patients had unfavorable outcome at 3 months. On multivariate analysis, low sodium was significant for 30-day mortality and high sodium was significant for unfavorable outcome at 3 months. After correction for multiple testing, however, no routine blood test remained significant.

CONCLUSION: No routine blood tests measured upon admission were significant predictors of outcome in patients with sTBI. Other clinical and radiological factors may at this point be better suited to predict outcomes in this patient population.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

blood tests; closed head injuries; outcome prediction; traumatic brain injury