Extracranial complications of severe head injury

Abstract

In order to define the role of intracranial and extracranial complications in determining outcome from severe head injury, 734 patients from the Traumatic Coma Data Bank were analyzed. Nine classes of intracranial and 13 classes of extracranial complications occurring within the first 14 days after admission were analyzed, while controlling for age, admission Glasgow Coma Scale motor score, early hypoxia or hypotension, and severe extracranial trauma. Outcome for survivors was based on the last recorded Glasgow Outcome Scale score, obtained a median of 521 days after injury. Intracranial complications did not significantly alter outcome for the study group. Of the extracranial complications, pulmonary, cardiovascular, coagulation, and electrolyte disorders occurred most frequently at 2 to 4 days. Infections developed later, peaking at 5 to 11 days. Gastrointestinal, renal, and hepatic complications followed no specific time course. Electrolyte abnormalities were the most frequent occurrence (59% of patients) but did not alter outcome. Pulmonary infections (41%), shock (29%, systemic blood pressure < or = 90 mm Hg for 30 minutes or more), coagulopathy (19%), and septicemia (10%) were significant independent predictors of an unfavorable outcome. Backward-elimination, stepwise logistic regression modeling indicated that the estimated reduction of unfavorable outcome was 2.9% for the elimination of pneumonia, 3.1% for coagulation disturbances, 1.5% for septicemia, and 9.3% for shock. These data suggest that extracranial complications are highly influential in determining the outcome from severe head injury and that significant improvements in outcome in a sizeable proportion of patients could be accomplished by improving the ability to prevent or reverse pneumonia, hypotension, coagulopathy, and sepsis.

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave

“…[21][22][23] Goodnight et al 9 suggest that the early treatment of coagulopathy may have contributed to a better prognosis of adult patients, which was described by other authors some years later. 6,14 A study with similar results carried out in children younger than 16 years was published only in 2001. 17 In that same year, however, Vavilala et al 18 could not prove there was a relationship between the treatment of the coagulation disorder and a more favorable prognosis in children.…”

“…6,11,13,14,17,20 20 The first study that included a larger number of variables and used a multivariate analysis Therefore, the question about the role of coagulopathy in the increase in the mortality of TBI patients remains unanswered. According to the findings of the present study, coagulation disorder is not a determining factor of mortality, but a marker of the severity of brain injury, which means that patients with such a disorder should be more closely and intensively monitored.…”

“…Several factors, such as hypotension and hypoxia, have been correlated with the development of secondary injuries. [1][2][3][4][5][6][7][8] Other factors, such as the presence of coagulation disorders, are currently being investigated, so as to define their importance among the complex factors that influence the prognosis of patients with traumatic brain injury (TBI).…”

Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring

“…1,42,43 Recognized prognostic factors that influence outcome, which are present early after injury, are early hypoxemia, early hypotension, severity of primary insult (assessed on computerized tomography [CT] scans), and admission Glasgow Coma Scale 50 (GCS) score. Adverse secondary events including sustained intracranial hypertension, 1,14,29,43,52 reduced or hyperemic cerebral blood flow (CBF), 25,46 and frank ischemia 45 influence outcome. These prognostic factors indicate that the brain exists in a vulnerable state during the first few days after trauma when secondary insults may worsen the injury and the resultant outcome.…”

Current Concepts in Diagnosis and Treatment of Traumatic Brain Injury: Implications for Healthcare in Nepal

“…The most common nosocomial infection in critical care patients with HI is pneumonia. 72 Its incidence has been progressively lowered during the last years, probably since corticosteroid treatment for HI is no longer favored and because general intensive care is qualitatively better today. Empiric, calculated or targeted antibiotic treatment is indicated based on the degree of suspicion or proof of infection.…”