Page 100 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 4
Patient outcome
In-hospital mortality was 38% and mortality increased to 44% during follow up (mean 37 ± 17 months). Mortality ranged from 23% for initial mild-TBI to 64% for patients with vs-TBI (Table 2). Favourable outcome (GOS 4-5) was seen in 46% of all patients, 72% of patients with mild-TBI and in 23% of patients with vs-TBI (Figure 1). High rates of unfavourable outcome (GOS 1-3) were seen in patients with a GCS of 3 (90%), ICP monitoring (75%), decompressive craniectomy (72%), pupillary abnormalities (70%) and age<65 (63%).
Twenty-five patients (42% of survivors) returned a completed QOLIBRI questionnaire. Return percentages were lower for patients with higher initial severity scores (9% for vs-TBI and 35% for mild TBI) and lower for patients with worse functional outcome (4% for GOS 1-3 vs. 46% for GOS 4-5). Mean QOLIBRI scores however were rather similar between TBI severity groups (61 ± 25 for s-TBI and 64 ± 24 for mild TBI). Patients with post-trauma pupillary abnormalities (49.8), ICP monitoring (55.1) and patients with unfavourable outcome (GOS 1-3) (50.5) showed mean QOLIBRI scores suggesting an impaired HRQoL. Patients receiving a craniotomy showed better scores (68.4) than patients receiving a decompressive craniectomy (53.2).
Healthcare consumption
Patients with vs-TBI had a significant longer ICU LOS than patients with mild TBI (6 vs. 2 days, P<0.001). (Table 3). Mean LOS for non-ICU admissions was longest for patients with moderate TBI (16 days), followed by 12 and 9 days for patients with vs-TBI and mild TBI. All vs-TBI and 98% of s-TBI patients received cranial surgery, compared to 89.5% of moderate and 62.5% of mild TBI patients. ICP monitoring was most frequently used in patients with vs-TBI and s-TBI (63.6% and 57.1%), but also in 12.5% of patients with mild TBI. ICP monitoring was associated with significant longer ICU and non-ICU LOS compared to non ICP-monitoring.
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