Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study.

Adult Brain Injuries Brain Injuries, Traumatic / complications Glasgow Coma Scale Humans Retrospective Studies Risk Factors

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
01 09 2022
Historique:
received: 05 01 2022
accepted: 03 04 2022
pubmed: 21 5 2022
medline: 11 8 2022
entrez: 20 5 2022
Statut: ppublish

Résumé

Extracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood. To identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock. We conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of <13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models. Of our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores <3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P < .001). We report potential risk factors for circulatory shock after moderate-severe TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.

Sections du résumé

BACKGROUND
Extracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood.
OBJECTIVE
To identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock.
METHODS
We conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of <13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models.
RESULTS
Of our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores <3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P < .001).
CONCLUSION
We report potential risk factors for circulatory shock after moderate-severe TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.

Identifiants

DOI: 10.1227/neu.0000000000002042 PMID: 35593705 PMC: PMC10553078
pubmed: 35593705
doi: 10.1227/neu.0000000000002042
pii: 00006123-202209000-00009
pmc: PMC10553078
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

427-436

Subventions

Organisme : NINDS NIH HHS
ID : K23 NS109274
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS086090
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS101123
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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Auteurs

Camilo Toro (C)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.

Jordan Hatfield (J)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
ORCID: 0000-0003-3336-7258

Nancy Temkin (N)

Department of Biostatistics, University of Washington, Seattle, Washington, USA.
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.

Jason Barber (J)

Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.

Geoffrey Manley (G)

Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, California, USA.

Tetsu Ohnuma (T)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Anesthesiology, Duke University, Durham, North Carolina, USA.

Jordan Komisarow (J)

Department of Neurosurgery, Duke University, Durham, North Carolina, USA.

Brandon Foreman (B)

Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Frederick K Korley (FK)

Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Monica S Vavilala (MS)

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.

Daniel T Laskowitz (DT)

Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
Department of Neurology, Duke University, Durham, North Carolina, USA.

Joseph P Mathew (JP)

Department of Anesthesiology, Duke University, Durham, North Carolina, USA.

Adrian Hernandez (A)

Department of Medicine, Duke University, Durham, North Carolina, USA.

John Sampson (J)

Department of Neurosurgery, Duke University, Durham, North Carolina, USA.

Michael L James (ML)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Neurology, Duke University, Durham, North Carolina, USA.

Karthik Raghunathan (K)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
Department of Anesthesiology, Duke University, Durham, North Carolina, USA.

Benjamin A Goldstein (BA)

Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA .

Amy J Markowitz (AJ)

Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, California, USA.

Vijay Krishnamoorthy (V)

Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
Department of Anesthesiology, Duke University, Durham, North Carolina, USA.

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Risk Factors and Neurological Outcomes...
questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions encéphaliques › Risk Factors and Neurological Outcomes...
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