Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

Büki, András; Czeiter, Endre; Kovács, Noémi; Amrein, Krisztina; Ezer, Erzsébet; Sándor, János; Dóczi, Tamás

doi:10.1007/s13670-012-0016-3

Cited by 3 publications

(3 citation statements)

References 45 publications

(40 reference statements)

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“…The duration of the post-traumatic ICU stay has been found to significantly influence the clinical course and outcome, even years after the initial trauma [38,37,[41][42][43][44][45]. Our finding that severe TBI is associated with an increased duration of both ICU treatment and mechanical ventilation in severely injured patients is supported by the literature.…”

Section: Impact Of Injury Pattern and Pneumonia On The Clinical Coursesupporting

confidence: 81%

Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

Hofman

Andruszkow

Kobbe

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Traumatic brain injury (TBI) and chest trauma are common injuries in severely injured patients. Both entities are well known to be associated with severe post-traumatic complications, including pneumonia, a common complication with a significant impact on the further clinical course. However, the relevance of TBI, chest trauma and particularly their combination as risk factors for the development of pneumonia and its impact on outcomes are not fully elucidated. Methods A retrospective analysis of poly-traumatized patients treated between 2010 and 2015 at a level I trauma centre was performed. Inclusion criteria were: Injury Severity Score ≥ 16 and age ≥ 18 years. TBI and chest trauma were classified according to the Abbreviated Injury Scale. Complications (i.e. acute respiratory distress syndrome (ARDS), multi-organ dysfunction syndrome (MODS) and pneumonia) were documented by a review of the medical records. The primary outcome parameter was in-hospital mortality. Results Over the clinical course, 19.9% of all patients developed pneumonia, and in-hospital mortality was 25.3%. Pneumonia (OR 5.142, p = 0.001) represented the strongest independent predictor of in-hospital mortality, followed by the combination of chest injury and TBI (OR 3.784, p = 0.008) and TBI (OR 3.028, p = 0.010). Chest injury alone, the combination of chest injury and TBI, and duration of ventilation were independent predictors of pneumonia [resp. OR 4.711 (p = 0.004), OR 4.193 (p = 0.004), OR 1.002 (p < 0.001)]. Conclusions Chest trauma alone and especially its combination with TBI represent high-risk injury patterns for the development of pneumonia, which forms the strongest predictor of mortality in poly-traumatized patients.

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Section: Impact Of Injury Pattern and Pneumonia On The Clinical Coursesupporting

confidence: 81%

Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

Hofman

Andruszkow

Kobbe

et al. 2019

Eur J Trauma Emerg Surg

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“…Moreover, VAP significantly increases the stay in the ICU and hospital, and is directly linked to a worse outcome [ 8 ]. Hospital-acquired pneumonia can even influence the global outcome after 5 years following severe TBI hospital-acquired pneumonia [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Twenty-Eight-Day Mortality of Blunt Traumatic Brain Injury and Co-Injuries Requiring Mechanical Ventilation

Jovanović

Milan²,

Djurić³

et al. 2016

Med Princ Pract

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Objective: This paper aims to assess the impact of co-injuries and consequent emergency surgical interventions and nosocomial pneumonia on the 28-day mortality of patients with severe traumatic brain injuries (TBIs). Subjects and Methods: One hundred and seventy-seven patients with TBI admitted to the emergency trauma intensive care unit at the Clinical Center of Serbia for more than 48 h were studied over a 1-year period. On admission, the Glasgow Coma Scale (GCS), Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation II score (APACHE II) were calculated. At admission, an isolated TBI was recorded in 45 of the patients, while 44 had three or more co-injuries. Results: Of the 177 patients, 78 (44.1%) died by the end of the 28-day follow-up period. They had a significantly higher ISS score (25 vs. 20; p = 0.024) and more severe head (p = 0.034) and chest (p = 0.013) injuries compared to those who survived. Nonsurvivors had spent more days on mechanical ventilation (9.5 vs. 8; p = 0.041) and had a significantly higher incidence of ventilator-associated pneumonia (VAP) than survivors (67.9 vs. 40.4%; p < 0.001). A high Rotterdam CT score (OR 2.062; p < 0.001) and a high APACHE II score (OR 1.219; p < 0.001) were identified as independent predictors of early TBI-related mortality. Conclusion: Patients who had TBI with a high Rotterdam score and a high APACHE II score were at higher risk of 28-day mortality. VAP was a very common complication of TBI and was associated with an early death and higher mortality in the subgroup of patients with a GCS ≤8.

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“…Thus the INRO now has data for over 1000 patients with severe TBI that have already been used for various analyses (Mauritz et al, 2009). 1 Glasgow Coma Scale score (GCS) and age are important prognostic indicators in patients with severe TBI (Hukkelhoven et al, 2003;Maas et al, 2007a). In all trials that were designed to investigate the effects of new medications for the treatment of severe TBI, patients aged over 65 years, as well as patients who had GCS scores <5, were excluded (Guha, 2004;Slieker et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old

Bražinová¹,

Mauritz

Leitgeb

et al. 2010

Journal of Neurotrauma

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The goal of this study was to investigate the outcomes of patients with traumatic brain injury (TBI) who had Glasgow Coma Scale (GCS) scores of 3 or 4, and were aged 66 years or older. Between January 2001 and December 2005, 13 European centers enrolled patients with severe brain trauma. Data sets of all patients who had a GCS score of 3 or 4 and were 66 years of age or older were analyzed. Outcomes were classified according to the Glasgow Outcome Scale (GOS) 12 months post-trauma as "favorable" (GOS score of 4 or 5), or "unfavorable" (GOS score of 1-3); relevant data for patients of the two groups were compared. Variables were analyzed by univariate analyses (chi-square, Wilcoxon-Mann-Whitney, and Fisher's exact tests), and a p value of <0.05 was considered significant. We analyzed 100 patients identified from the database as having GCS scores of 3 or 4 and age over 65 years. Factors having significant effects on outcomes were worse results of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and Abbreviated Injury Scale (AIS) for the head. Closed or partially closed basal cisterns and/or midline shift >15 mm were also associated with unfavorable outcomes, as was subarachnoid hemorrhage (SAH). Patients with GCS scores of 3 or 4 who are older than 65 years have a poor, but not hopeless, prognosis. Confirmed factors predicting poor prognosis for this group of patients were closed basal cisterns and midline shift >15 mm on the first CT scan. Factors possibly related to favorable outcomes were female gender, lower trauma severity, open or partially open basal cisterns, and no midline shift on the first CT scan.

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Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

Cited by 3 publications

References 45 publications

Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

Twenty-Eight-Day Mortality of Blunt Traumatic Brain Injury and Co-Injuries Requiring Mechanical Ventilation

Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old

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