Prognostic factors for mortality in patients with severe traumatic brain injury in Yogyakarta, Indonesia

https://doi.org/10.19106/JMedSci005202202003

Desin Pambudi Sejahtera(1*), Ismail Setyopranoto(2), Sri Sutarni(3), Tri Ratnaningsih(4), Mawaddah Ar Rochmah(5), Indarwati Setyaningsih(6)

(1) Department of Neurology. Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada//Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(2) Department of Neurology. Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada//Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(3) Department of Neurology. Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada//Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(4) Department of Clinical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(5) Department of Neurology. Faculty of Medicine, Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(6) Department of Neurology. Faculty of Medicine, Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(*) Corresponding Author

Abstract


Determining an accurate prognosis in patients with severe traumatic brain injury (TBI) still becomes a difficult challenge for neurologists. Clinical and laboratory findings have been used as important parameters to establish clinical decisions or even predict future prognosis including death in
these patients. We studied the clinical, laboratory and neuroimaging parameters in predicting mortality in patients with severe TBI. This study used the medical records of severe TBI cases in Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January 2015 until July 2016. We
evaluated the clinical, laboratory, and neuroimaging examinations of seventy patients with severe TBI in association with mortality. The result showed among 70 patients involved, 35 were dead. Clinical findings of age <40 y.o. (OR=1.143; p=0.015), multiple injuries (OR=5.712; p=0.045),
and systolic blood pressure >140 mmHg (OR=3.852; p=0.008) were associated with mortality. Laboratory and neuroimaging parameters of hyponatremia (OR=3.667; p=0.027), hyperkalemia (OR=1.771; p=0.030), and the presence of traumatic subarachnoid hemorrhage (SAH) (OR=6.526;
p=0.003) in head CT-scan were significantly associated with mortality. In conclusion, our study showed that productive age <40 y.o. multiple injuries, hyponatremia, hyperkalemia and the presence of traumatic SAH increase the mortality risk in patients with severe TBI.

Keywords


severe traumatic brain injury; subarachnoid hemorrhage; increased blood pressure; hyponatremia; hypercalemia; mortality;

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References

  1. Avarello JT, Cantor RM. Pediatric major trauma: an approach to evaluation and management. Emerg Med Clin North Am 2007; 25(3):803-36. https://doi.org/10.1016/j.emc.2007.06.013
  2. Marik PE, Varon J, Trask T. Management of head trauma. Chest 2002; 122(2):699-711. https://doi.org/10.1378/chest.122.2.699
  3. Frey KL, Rojas DC, Anderson A, Arciniegas DB. Comparison of the O-log and GOAT as measures of posttraumatic amnesia. Brain Injury 2007; 21(5):513-20. https://doi.org/10.1080/02699050701311026
  4. Irawan H, Setiawan F, Dewi, Dewanto G. Perbandingan Glasgow coma scale dan revised trauma score dalam memprediksi disabilitas pasien trauma kepala di Rumah Sakit Atma Jaya. Majalah Kedokteran Indonesia 2010; 60(10):437-42.
  5. Japardi I. Penatalaksanaan cedera kepala akut. Medan: Bagian Bedah, Fakultas Kedokteran, Universitas Sumatra Utara, 2002.
  6. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. Surveillance for traumatic brain injury-related death United States, 1997-2007. MMWR Surveill Summ 2011; 60(5):1-32.
  7. Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 2007; 99(1):18-31. https://doi.org/10.1093/bja/aem128
  8. McHugh GS, Engel DC, Butcher I, Steyerberg EW, Lu J, Mushkudiani N, et al. Prognostic value of secondary insults in traumatic brain injury: Results from the IMPACT study. J Neurotrauma 2007; 24(2):287-93. https://doi.org/10.1089/neu.2006.0031
  9. Bader MK. Recognizing and treating ischemic insults to the brain: the role of brain tissue oxygen monitoring. Crit Care Nurs Clin North Am 2006; 18(2):243-56. https://doi.org/10.1016/j.ccell.2006.01.003
  10. Barton CW, Hemphill JC, Morabito D, Manley G. A novel method of evaluating the impact of secondary brain insults on functional out comes in traumatic brain-injured patients. Acad Emerg Med 2005; 12(1):1-6. https://doi.org/10.1197/j.aem.2004.08.043
  11. Perhimpunan Dokter Spesialis Saraf Indonesia. Konsensus Nasional Penanganan trauma kapitis dan trauma spinal. Jakarta: Bagian neurologi Fakultas Kedokteran, Universitas Indonesia/Rumah Sakit Dr. Cipto Mangunkusumo, 2006.
  12. Lang EW, Czosnyka M, Mehdorn M. Tissue oxygen reactivity and cerebral auto-regulation after severe traumatic brain injury. Crit Care Med 2003; 31(1):267-71. https://doi.org/10.1097/00003246-200301000-00042
  13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 1996; 40(5):764-67. https://doi.org/10.1097/00005373-199605000-00014
  14. Valadka AB & Robertson CS. Surgery of cerebral trauma and associated critical care. Neurosurgery 2007; 61(1):203-21. https://doi.org/10.1227/01.NEU.0000255497.26440.01
  15. Sastrodiningrat AG. Pemahaman indikator-indikator dini dalam menetukan prognosa cedera kepala berat. Medan: Bagian Bedah, Fakultas Kedokteran, Universitas Sumatera Utara, 2007.
  16. Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 2005; 103(5):805-11. https://doi.org/10.3171/jns.2005.103.5.0805
  17. Dumont TM, Visioni AJ, Rughani AI, Tranmer BI, Crookes B. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma 2010; 27(7):1233-41. https://doi.org/10.1089/neu.2009.1216
  18. Henzler D, Cooper DJ, Mason K. Factors contributing to fatal outcome of traumatic brain injury: a pilot case control study. Crit Care Resusc 2001; 3(3):153-7.
  19. Popović VV, Lesjak VB, Pelcl T, Strnad M. Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury. Signa Vitae 2014; 9(1):42-6. https://doi.org/10.22514/SV91.042014.7
  20. Bardt TF, Unterberg AW, Härtl R, Kiening KL, Schneider GH, Lanksch WR. Monitoring of brain tissue pO2 in traumatic brain injury: effect of cerebral hypoxia on outcome. Acta Neurochir Suppl 1998; 71:153-6 https://doi.org/10.1007/978-3-7091-6475-4_45
  21. Van Santbrink H, vd Brink WA, Steyerberg EW, Suazo JAC, Avezaat CJ, Maas AI. Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir 2003; 145(6):429-38. https://doi.org/10.1007/s00701-003-0032-3
  22. Jousi M, Reitala J, Lund V, Katila A, Leppäniemi A. The role of pre-hospital blood gas analysis in trauma resuscitation. World J Emerg Surg 2010; 5:10. https://doi.org/10.1186/1749-7922-5-10



DOI: https://doi.org/10.19106/JMedSci005202202003

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