Research Reports - Subacute complications during recovery from severe traumatic brain injury

BMJ Open. 2015 May 3;5(4)

Godbolt AK(1), Stenberg M(2), Jakobsson J(3), Sorjonen K(4), Krakau K(5),
Stålnacke BM(2), Nygren DeBoussard C(5)

BACKGROUND: Medical complications after severe traumatic brain injury (S-TBI) may
delay or prevent transfer to rehabilitation units and impact on long-term
outcome.
OBJECTIVE: Mapping of medical complications in the subacute period after S-TBI
and the impact of these complications on 1-year outcome to inform healthcare
planning and discussion of prognosis with relatives.
SETTING: Prospective multicentre observational study. Recruitment from 6
neurosurgical centres in Sweden and Iceland.
PARTICIPANTS AND ASSESSMENTS: Patients aged 18-65 years with S-TBI and acute
Glasgow Coma Scale 3-8, who were admitted to neurointensive care. Assessment of
medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114
patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and
7 dropped out.
OUTCOME MEASURE: Glasgow Outcome Scale Extended.
RESULTS: 68 patients had ≥1 complication 3 weeks after injury. 3 weeks after
injury, factors associated with unfavourable outcome at 1 year were:
tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition
via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube
(univariate logistic regression analyses). Multivariate analysis demonstrated
that tracheostomy and epilepsy retained significance even after incorporating
acute injury severity into the model. 3 months after injury, factors associated
with unfavourable outcome were tracheostomy and heterotopic ossification
(Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and
weight loss (univariate logistic regression). PEG feeding and weight loss at
3 months were retained in a multivariate model.
CONCLUSIONS: Subacute complications occurred in two-thirds of patients. Presence
of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at
3 months, had robust associations with unfavourable outcome that were
incompletely explained by acute injury severity.

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