Research Reports - Association between hyperglycaemia with neurological outcomes following severe head trauma

J Clin Diagn Res. 2016 Apr;10(4):PC11-3. doi: 10.7860/JCDR/2016/17208.7686. Epub
2016 Apr 1.

Khajavikhan J(1), Vasigh A(1), Kokhazade T(2), Khani A(2).

INTRODUCTION: Head Trauma (HT) is a major cause of death, disability and
important public health problem. HT is also the main cause of hyperglycaemia that
can increase mortality.
AIM: The aim of this study was to assess the correlation between hyperglycaemia
with neurological outcomes following severe Traumatic Brain Injury (TBI).
MATERIALS AND METHODS: This is a descriptive and correlation study that was
carried out at the Imam Khomeini Hospital affiliated with Ilam University of
Medical Sciences, Ilam, IR, during March 2014-March 2015 on patients with severe
TBI. Data were collected from the patient records on mortality, Intensive Care
Unit (ICU) length of stay, hospital length of stay, admission GCS score, Injury
Severity Score (ISS), mechanical ventilation, Ventilation Associated Pneumonia
(VAP) and Acute Respiratory Distress Syndrome (ARDS). Random Blood Sugar (RBS)
level on admission was recorded. Patients with diabetes mellitus (to minimize the
overlap between acute stress hyperglycaemia and diabetic hyperglycaemia) were
RESULTS: About 34(40%) of patients were admitted with hyperglycaemia (RBS ≥ 200
mg/dl) over the study period. The mortality rate, length of ICU stay, hospital
stay, ISS and VAP & ARDS in patients with RBS levels ≥ 200 mg was significantly
higher than patients with RBS levels below ≤ 200mg (p<0.05, p<0.001). A
significant correlation was found between RBS with GCS arrival, length of ICU
stay, length of hospital stay, ISS, mechanical ventilation and VAP & ARDS
(p<0.05, p< 0.001). RBS is a predicate factor for ISS (p <0.05, OR : 1.36), GCS
(p <0.001, OR : 1.69), mechanical ventilation (p< 0.05, OR : 1.27), VAP & ARDS (p
<0.001, OR : 1.68), length of ICU stay (p <0.001, OR : 1.87) and length of
hospital stay (p <0.05, OR : 1.24).
CONCLUSION: Hyperglycaemia after severe TBI (RBS ≥ 200) is associated with poor
outcome. It can be a predictive factor for mortality rate, ICU stay, GCS arrival,
VAP & RDS, hospital stay and ISS. Management of hyperglycaemia with insulin
protocol in cases with value >200mg/dl, is critical in improving the outcome of
patients with TBI.

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