Page 43 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
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Decision-making in very severe traumatic brain injury
Surgical intervention.
DC(≥35cm2): 48 Unilateral: 42 Bilateral: 6
<16h trauma: 28 <48h trauma: 48
Primary: 187 Secondary: 14 Unilateral: 183 Bilateral: 8 Bifrontal: 10 <24h trauma: 166
Unilateral: 66% Bilateral: 34%
94 < mean17.1h
6 after secondary ICP increase.
Conventional DC: 106 Multi-dural stabs technique: 119
1: Ultra-early DC<4h: 60
2: DC>4h: 67
Early DC (±1h after admission): 85.9% Secondary: 14.1% (4-6 days).
8.2% bilateral.
Unilateral DC: 96.4% Bilateral DC: 3.6% <6h admission: 71.4%
Uni/bilateral FTPC (with/without vascular tunnel construction). <4h admission: 20
Uni/bilateral FTPC ±5 hours from trauma
Outcome measure
GOS
30- day Mortality
GOS (6M)
Discharge GOS
Mortality / mRS
GOS (6M/12M)
Mortality/ GOSE (6M)
GOS
Mortality (30d)/ GOS (6M)
Results
GOS1: Overall:12.5%, GCS3-5: 16%, GCS6-8:11% 2 GOS2: GCS3-5: 37%, GCS6-8: 7%
Favourable (GOS4+5): Overall: 55%, GCS3-5: 37%, GCS6-8: 67%
LTFU: 2 (Mean FU 14 months)
Mortality: Overall: 26.4%, GCS9-15: 4.4%. GCS6-8: 12.4%, GCS3-5: 59.7%
>90% died within 14 days.
Unfavourable (GOS1-3): Overall: 84%, GCS4-5: 96.6%, GCS6-8: 65% Favourable (GOS4-5): Overall: 16%, GCS4-5: 3.4%, GCS6-8: 25%
Conventional GCS3-4: GOS1: 59%, GOS (2+3): 22%, GOS (4+5): 19% SKIMS GCS3-4: GOS1: 36.7%, GOS(2+3): 33.3%, GOS (4+5): 30%
Mortality: Overall: 68.5%,
DC<4h: 65.0%, DC>4h: 71.6%, (p: 0.430) Mortality: GCS3: 100%, GCS4-5: 82.2%,
GCS>5: 41%
Favourable (mRS0-2): GCS3-5: 0%, GCS>6: 4.7%
At surgery: Mortality 1.9%, morbidity 31.9%.
6M (overall): GOS1: 11%, GOS2: 26%, GOS3: 9%, GOS4: 26%, GOS5: 28%
12M (overall): GOS1: 11%, GOS2: 6%, GOS3: 15%, GOS4: 25%, GOS5: 43%
Other: >60Y + GCS ≤5 (N=11) = 100% GOS<4. Poorer outcome in higher ICP and GCS <5
Mortality: All: 58.9%, GCS4-5: 79.3%, GCS>5: 37% Unfavourable(GOSE1-4): All: 78.5%, GCS4-5: 89.7%
Group 1: GOS1: 39.3%, GOS4-5: 42.9%, GOS2-3: 17.8% Group 2: GOS1: 80%, GOS4-5: 10%, GOS2-3: 10%
30d: Mortality: Overall: 38.2%, GCS≤5: 64%,
GCS>5: 26% (P=0.042), GCS3 (N=3): 100%, GCS4 (N=5): 80%
6M: Mortality: 47%, GOS2: 20%. Favourable (GOS4-5): Overall: 35%, GCS≤5: 9%, GCS>5: 45% Unfavourable (GOS1-3): GCS≤5: 91%, GCS>5: 55%
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