Page 45 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
P. 45
Decision-making in very severe traumatic brain injury
Surgical intervention.
LDC: 10cm x (13-15) cm RDC: 6-8 cm diameter
Unilateral DC: 58. Bilateral DC: 2.
Mean size 100cm2 <6h: 33%. 6-24h: 12%
FTPC: 49 Bifrontal:1 <48h: 34%
Unilateral FTPC:50 Bilateral FTPC: 5 <5h: 29%
>10h: 35%
Group 1: Unilateral: 22. Bilateral: 14.
Group 2: Bilateral:40
1: DC for mass lesion: 93
2: DC for diffuse injury and swelling: 71
≤24h after admission: 76% (N=122) Unilateral: 88% Bilateral: 12%
Bilateral FTPC (with/ without vascular tunnel construction).
Outcome measure
GOS (6M)
Mortality/ GOS (3/24M)
Mortality/ GOS (3M)
GOS (12- 102M)
GOS (12M)
Mortality (60d)/ GOS
GOS (discharge / 6M)
GOS
Results
Satisfactory (GOS3-5): GCS3-8: LDC 71.1%, RDC: 58.6% (P<0.05), GCS3- 2 5: LDC 63%, RDC 36.7% (P<0.01)
LDC (GCS3-5): GOS1: 30%, GOS2: 7%, GOS 3-5: 63%
RDC (GCS3-5): GOS1: 57%, GOS2: 6%, GOS 3-5: 37%
Mortality: GCS3-5: 50%, GCS6-8: 12%, GCS>8: 12%
Unfavourable (GOS2+3): GCS3-5: 54%, GCS6-8: 20%, GCS>8: 20%. Favourable (GOS4+5): GCS3-5: 46%, GCS6-8: 80%, GCS>8: 80%. All significant
Mortality (30d): Overall: 28%, GCS 3-5: 20%, GCS 6-8: 21.7%, GCS 9-15: 25%.
Good outcome (GOS4+5): Overall: 51.3%, GCS 3-5: 16.7%, GCS6-8: 66.7%, GCS 9-15: 66.7%.
GOS1: Overall: 39%. Favourable (GOS4-5) Overall: 47% GCS3-5: 26.7%, GCS6-8: 76.9%, GCS9-15: 66.7%
Unfavourable (GOS1-3) GCS3-5: 76.3%, GCS6-8: 23.1%, GCS9-15: 33.3% Age>65 + GCS3–5 (N=11): 100%
Favourable (GOS4+5): Group 1: 27.8%,
Group 2: 50%
GCS4-5: GOS1: 50%, GOS2+3: 25%, GOS4+5: 25% GCS6-8: GOS1: 20%, GOS2+3: 35%, GOS4+5: 45%
Overall: GOS1: 22%, GOS4-5: 42%
Mortality: Group 1/Group 2: 14% / 32.4%
Mortality: GCS3-5: 27.5%, GCS6-8: 26.9%,
GCS9-12=13.1%. P=0.197
Good outcome (GOS4-5) (%): GCS3-5: 29.7%, GCS6-8: 52.6%, GCS9-12: 71.7% P=0.002
Mortality: Overall: 44.7%, GCS3-5: 59%, GCS>5: 35% (p=0.004). Surgery ≤24h: (discharge): GOS1: GCS3-5: 68%, GCS6-8: 42%, GOS4- 5: GCS3-5: 26%, GCS6-8: 41.7% (p=0.013) (6M): GOS1: GCS3-5: 26.7% GCS6-8: 61.7% GOS4-5: GCS3-5: 6.7%, GCS6-8: 14.7% (p=0.013)
Group 1: GOS1: 40%, GOS4-5: 40%, GOS2-3: 20% Group 2: GOS1: 80%, GOS4-5: 10%, GOS2-3: 10%
43
