Page 125 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Functional outcome and in-hospital costs after traumatic brain injury
Study cohort
The predominance of male gender, injury mechanisms (road traffic accidents and falls)
and distribution of TBI severity were in accordance with recent literature. 1,24-26 The mean
age of 56 years was rather high compared to earlier research 24, but matched changing epidemiological patterns. 2 The number of intracranial CT abnormalities in mild TBI
patients was higher compared to literature (45.2% vs. 16.1%). 27 This is likely caused by
different inclusion criteria (hospital admission after TBI vs. ED presentation with head
CT after suspected TBI)and differences in accuracy between central and local radiological
reading. 18 The number of patients with major extracranial injury (AIS≥3) and pupillary abnormalities was also higher compared to literature 28,29 and the overall CENTER-
TBI Core study cohort. 9 These factors, with other factors like comorbidities and use of 5 anticoagulants, could have negatively influenced patient outcome and/or increased the
reported in-hospital healthcare consumption and in-hospital costs in this study.
Patient outcome
Mortality rates were generally high, but difficult to compare with other studies due to methodological differences. 2,30,31 One meta-analysis reported higher ‘all time point’ mortality rates for patients of all TBI severities 32, while other studies showed lower mortality rates for mild TBI 33, moderate TBI 31, and severe TBI. 30,34 Favourable outcome (6-month GOSE) rates were generally higher in literature. 35 30 31 Differences in patient outcome can largely be explained by patient related factors that are known to be associated with worse outcome. Such factors include higher age, higher injury severity, poorer initial neurologic condition and higher TBI severity (defined by GCS) and are reported above average in our cohort. 32,36,37 For instance, the inclusion of patients with a GCS=3 and/or bilateral pupillary abnormalities influences the comparison of patient outcome, as they are typically excluded in literature because of their often-perceived dismal prognosis. 38 That even the most severely injured patients were able to achieve favourable outcome and even full recovery, although rarely, has been reported previously. 36
The increase in mortality rates (12.3% to 15%) and data on persisting deficits and disabilities after 6 months confirm the need for increased vigilance and attention for rehabilitation or long-term care opportunities. Sustained health problems after TBI have also been reported by long-term follow up studies 39-42, some reporting deterioration between 5 and 10 years 43, others reporting remaining functional limitations up to 20 years after moderate and severe TBI. 44 Long term impairments are not limited to severe TBI, but are also reported after mild TBI. 7,8 Despite the short 6-month follow up, our results support statements that consider TBI to be an acute
123