Page 121 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Functional outcome and in-hospital costs after traumatic brain injury
Patient outcome
Mean in-hospital mortality was 12.3% and ranged from 2.3% for patients with mild TBI to 62.7% for patients with very severe TBI. (Table 1) The 6-month GOSE follow-up was available for 417 patients (85.8%). Favourable outcome (GOSE≥5) was achieved by 85.4% of patients with mild, 55.3% with moderate, 29.0% with severe, and 19.6% with very severe TBI. (Figure 1) A GOSE of 2-4 was found in 40 survivors (8.2%), of which 17 (3.5%) were in a vegetative state (GOSE=2) or required full assistance in daily life (GOSE=3). Nearly a third of patients reported full recovery (GOSE=8) after mild (32.5%), 18.6% after moderate, 6.4% after severe, and 5.9% after very severe TBI.
5
Figure 1. Patient outcome
Figure 1 shows in-hospital mortality and functional outcome (favourable: GOS 5-8, unfavourable GOS 1-4) at 6
month follow-up for patients with TBI in different severities.
Length of stay and surgical interventions
Mean total LOS was 8 days (2 days on ICU and 6 days non-ICU). LOS significantly increased with TBI severity, presence of major extracranial injury, surgical intervention(s) and presence of all types of intracranial abnormalities except epidural hematoma. (Table 2, Figure 2) Patients that required ICP monitoring and/or a decompressive craniectomy showed longest mean LOS (27 and 28 days respectively). LOS was short in patients without intracranial abnormalities (5 days). Patients with two non-reacting pupils also showed a significantly shorter LOS (5 days) compared to those with either one (17 days) or two reacting pupils (8 days).
A total of 126 patients (27.2%) received a surgical intervention, of which 67 intracranial (13.8%) and 65 extracranial (13.4%). Intracranial surgery was significantly more common in more severely injured TBI subgroups (6.2% for mild, 34.9% for moderate, and 35.9% for severe TBI). (Table 2).
119