TY  - JOUR
PY  - 2018//
TI  - The outcome of severe traumatic brain injury in Latin America
JO  - World neurosurgery
A1  - Bonow, Robert H.
A1  - Barber, Jason
A1  - Temkin, Nancy R.
A1  - Videtta, Walter
A1  - Rondina, Carlos
A1  - Petroni, Gustavo
A1  - Lujan, Silvia
A1  - Alanis, Victor
A1  - La Fuente, Gustavo
A1  - Lavadenz, Arturo
A1  - Merida, Roberto
A1  - Jibaja, Manuel
A1  - Gonzáles, Luis
A1  - Falcao, Antonio
A1  - Romero, Ricardo
A1  - Dikmen, Sureyya
A1  - Pridgeon, James
A1  - Chesnut, Randall M.
SP  - e82
EP  - e90
VL  - 111
IS  - 
N2  - Traumatic brain injury (TBI) disproportionately affects lower and middle income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries (HIC). This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥ 13 years and admitted to study hospitals with GCS ≤ 8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) at six months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. 550 patients were identified. Six month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E of 5-8. In multivariable proportional odds modeling, higher GCS motor (OR 1.41 per point, 95% CI 1.23-1.61) and epidural hematoma (OR 1.83, 95% CI 1.17-2.86) were significant predictors of higher GOS-E, whereas advanced age (OR 0.65 per 10 years, 95% CI 0.57-0.73) and cisternal effacement (P <.001) were associated with lower GOS-E. Notably, study site (P <.001) and race (P =.004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary exam. Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to HIC. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations.<br><br>Copyright © 2017 Elsevier Inc. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 1878-8750
UR  - http://dx.doi.org/10.1016/j.wneu.2017.11.171
ID  - ref1
ER  -