Research Reports - Effect of diabetes mellitus on outcome in patients with traumatic brain injury
Brain Inj. 2012 Dec 19
Lustenberger T, Talving P, Lam L, Inaba K, Bass M, Plurad D, Demetriades D
Background: Diabetes mellitus (DM) is associated with worsened outcomes following
severe injury. However, clinical studies evaluating the effect of DM on outcomes
in patients suffering traumatic brain injury (TBI) are currently lacking.
Methods: This was a National Trauma Databank (NTDB) study over a 5-year period.
Patients with DM were matched with victims of isolated TBI without DM in a 1:2
ratio. Outcomes included mortality, hospital and surgical intensive care unit
(SICU) length of stay, ventilator days and discharge disposition. Results: Of the
35 005 patients with isolated TBI, 636 (1.8%) cases had documented DM. After
matching 1272 counterparts without DM, no differences with regards to demographic
and injury characteristics were observed comparing the two groups. Overall
mortality in the study population was 18.8% (n = 358), with a significantly
increased in-hospital mortality in patients with vs without DM [22.6% vs 16.8%;
OR (95% CI): 1.45 (1.14-1.83); p = 0.002]. Patients with DM were significantly
less frequently discharged home compared to their counterparts without DM [38.9%
vs 46.1%; OR (95% CI): 0.75 (0.60-0.93); p = 0.008]. Conclusion: Traumatic brain
injury in conjunction with diabetes mellitus is associated with an almost
1.5-fold increased mortality while compared to patients with isolated TBI without
diabetes mellitus. Prospective validation of these findings is warranted to
determine the underlying aetiology.