Page 99 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Table 1. Patient cohort information
Number of patients Age (years)
Male
Trauma mechanism Fall
Assault
Motor vehicle accident Fall from bike
Other
TBI severity
Very severe (GCS3-5) Severe (GCS3-8) Moderate (GCS9-12) Mild (GCS13-15)
Clinical parameters
GCS score
Pupil abnormality *
Focal Neurologic symptoms Major extracranial injury
CT parameters
Thickness (mm)
Midline shift (mm) Concomitant lesion
Basal cisterns compressed
108
65 ± 17.3 57 (52.8)
58 (53.7) 5 (4.6) 12 (11.1) 12 (11.1) 21 (19.4)
22 (20.4) 49 (45.4) 19 (17.6) 40 (37.0)
9,63 ± 4.3 27 (26.7) 42 (38.9) 12 (11.1)
13.6 ± 6.1 11.4 ± 6.6 48 (44.4) 39 (36.1)
Number of patients Age (years)
Male
Treatment Conservative Emergent surgical
intervention:
- Craniotomy
- Decompressive craniectomy
(DC)
- ICP monitoring
In-hospital mortality
Functional outcome GOS1-3 (unfavourable) GOS4-5 (favourable) Missing GOS
QOLIBRI response
FU time, months
Yes
No (died; too disabled) No, other
108
65 ± 17.3 57 (52.8)
18 (16.7) 90 (83.3)
- 60 (55.6) - 29 (26.9)
- 40 (37.0) 41 (37.9)
56 (51.9) 50 (46.3) 2 (1.9)
46 ± 16 25 (23.1) 53 (48; 5) 30 (27.8)
Outcome versus in-hospital costs: a neurosurgical paradox?
RESULTS
Out of 294 initially identified TBI patients, 140 patients did not have a t-ASDH, 6 had
penetrating injuries, 9 required surgery for concomitant intracranial lesions and 31
patients were excluded following the other exclusion criteria. Ultimately, 108 patients
were included in this study. The final study cohort included 57 males (52.8%) and had
a mean age of 65 years (range 18-91) (Table 1). Most ASDH patients (N=49) sustained a
severe TBI (s-TBI) followed by mild (N=40) and moderate TBI (N=19). Of patients with
s-TBI, 22 were classified as having sustained a vs-TBI. A quarter of all patients had at least 4 1 non-reactive pupil (N=27) and 38.9% had focal neurologic symptoms. A concomitant
intracranial hematoma that not required surgical intervention was present in 44.4% of patients and 11.1% had clinically relevant extracranial injuries. Neurosurgical intervention was performed in 90 patients (60 craniotomies, 29 decompressive craniectomies and 1 burr hole) and an ICP monitoring device was placed in 40 patients. Most of the conservatively treated patients (N=18) were classified as mild TBI (83%).
Table 1 provides general information about the patient cohort.
Legend:
N (%) or mean ± SD, unless stated otherwise
* At least one pupil unresponsive to light upon arrival in the emergency room (missing for 7 patients) Abbreviations:
SD, standard deviation; GCS, Glasgow Coma Score; CT, computed tomography; DC, decompressive craniectomy; ICP, intracranial pressure; GOS, Glasgow outcome score; QOLIBRI, quality of life after brain injury; FU: Follow-up
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