%0 Journal Article %T Conscious status predicts mortality among patients with isolated traumatic brain injury in administrative data %J American journal of surgery %D 2016 %A Alsulaim, Hatim A. %A Smart, Blair J. %A Asemota, Anthony O. %A Haring, R. Sterling %A Canner, Joseph K. %A Efron, David T. %A Haut, Elliott R. %A Schneider, Eric B. %V 214 %N 2 %P 207-210 %X BACKGROUND: Outcome studies in trauma using administrative data traditionally employ anatomy-based definitions of injury severity; however, physiologic factors, including consciousness, may correlate with outcomes. We examined whether accounting for conscious status in administrative data improved mortality prediction among patients with moderate to severe TBI.

METHODS: Patients meeting Centers for Disease Control and Prevention (CDC) guidelines for TBI in the 2006 to 2011 Nationwide Emergency Department Sample were identified. Patients were dichotomized as having no/brief loss of consciousness (LOC) vs extended LOC greater than 1 hour using International Classification of Diseases, Ninth Revision (ICD-9) fifth digit modifiers. Receiver operating curves compared the ability of logistic regression to predict mortality in models that included LOC vs models that did not.

RESULTS: Overall, 98,397 individuals met criteria, of whom 25.8% had extended LOC. In univariate analysis, AIS alone predicted mortality in 69.6% of patients (area under receiver operating characteristic curve.696, 95% CI.689 to.702), extended LOC alone predicted mortality in 76.8% (AUROC.768, 95% CI.764 to.773), and a combination of AIS and extended LOC predicted mortality in 82.6% of cases (AUROC.826, 95% CI.821 to.830). Similar differences were observed in best-fit models.

CONCLUSIONS: Accounting for LOC along with anatomical measures of injury severity improves mortality prediction among patients with moderate/severe TBI in administrative datasets. Further work is warranted to determine whether other physiological measures may also improve prediction across a variety of injury types.

Copyright © 2016 Elsevier Inc. All rights reserved.

Language: en

%G en %I Elsevier Publishing %@ 0002-9610 %U http://dx.doi.org/10.1016/j.amjsurg.2016.07.012