%0 Journal Article
%T Concomitant chest trauma and traumatic brain injury, biomarkers correlate with worse outcomes
%J Journal of trauma and acute care surgery
%D 2019
%A Crawford, Angela M.
%A Yang, Shiming
%A Hu, Peter
%A Li, Yao
%A Lozanova, Petya
%A Scalea, Thomas M.
%A Stein, Deborah M.
%V ePub
%N ePub
%P ePub-ePub
%X 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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>
%G en
%I Lippincott Williams and Wilkins
%@ 2163-0755
%U http://dx.doi.org/10.1097/TA.0000000000002256