Page 47 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Decision-making in very severe traumatic brain injury
Surgical intervention.
Neurosurgery: 43 Not further specified.
1: Conservative 66%
2: Surgery 34%
Internal decompression with/without external decompression:
90% Only external decompression: 10% <24h in 73%
Craniotomy: 87% Craniectomy: 13% <4h arrival: 83% Mean time: 1.9h
Neurosurgical procedures: BFDP 16.4% and RP 34.8% (P=0.005)
Conservative 22.5%. Unilateral 48.8%. Bilateral 28.8% (78.3% simultaneously).
EDH:37%, ASDH: 10% Removal contusion/ lobectomy: 33% Persistent brain swelling (DC): 21%.
50% <24h.
Large craniotomy. Surgery in 156 patients. GCS3-5 + Surgery: 26
Surgery: Overall: 91 GCS3-5: 13
Outcome measure
GOS (12M)
GOS (6M)
Mortality (discharge) / favorable (home, rehabilitation)
/ FIM Mortality
Mortality/ GOS (6M)
Mortality/ GOS.
Mortality/ GOS (hospital discharge)
GOS
Results
Total group: Poor outcome (GOS1-3): Field GCS: 91.3%, PR- GCS: 96%
Good outcome (GOS4-5): Field GCS: 8.7%, PR-GCS: 4%
≥1 reactive pupil (N=18): Good outcome: 28%
After neurosurgery (N=43): Good outcome: 9.3%, non- significant
Surgical GCS3-5 (N=11): GOS1: 55%, GOS2: 0%, GOS3: 27%, GOS4: 9%, GOS5: 9%.
Conservative GCS3-5 (N=47): GOS1: 70%, GOS2: 11%, GOS3: 11%, GOS4: 2%, GOS5: 7%.
Surgical GCS6-8 (N=21): GOS1: 14%, GOS2: 10%, GOS3: 24%, GOS4: 29%, GOS5: 24%
Conservative GCS6-8 (N=58): GOS1: 29%, GOS2: 10%, GOS3: 10%, GOS4: 21%, GOS5: 29%
Overall mortality GCS=3: 48% (9% Emergency room) Overall survivors (favorable): 74%.Overall FIM: (feeding/ expression/locomotion): 61%, 63%, 38%.
Survival: CRANI/no CRANI: 61%/50% (P=0.04) Favorable (home/rehab): CRANI/no CRANI: 39%/39% Matched mass lesion population:
Survival: CRANI/no CRANI: 65%/34%
Favorable outcome: CRANI/no CRANI: 43%/26%
Mortality: GCS3 + BFDP: 100% GCS3+RP: 42% (P<0.0001)
Overall mortality: 31.3%, Unfavorable (GOS1-3): 56.3% Surgical group:
GCS3–5: GOS1: 53.3%, GOS2: 26.7%, GOS3: 20.0% GCS≥6: GOS1: 14.9%, GOS2: 6.4%, GOS3: 17%
LTFU: 3.8%
In-hospital mortality: 79%. Overall: 83%.
Mortality isolated ASDH: 100%. >60 years: 100%
70% of survivors, operated <24h
GOS4-5: Overall: 14%, EDH: 26%, CC: 11%, ASDH/CC: 5% LTFU: 3%
Overall mortality: 65%
Mortality: GCS3-5: 98.5% (PVS:1.5%), UDP: 96%, MF:100% After surgery:
GCS3-5: Death: 92.5%, PVS: 7.5%
GCS6-8: Death: 62.5%, GOS4-5: 22.5%
GCS9-12: Death 22%, GOS4-5: 67.5%
GCS13-15: Death: 9%, GOS4-5: 91%
Satisfactory (GOS3-5): Overall: 50.3%, surgery: 71.4%
Poor (GOS1-2): Overall: 49.7%, surgery: 29.9%
Poor outcome (GOS 1-2): GCS3-5: 94%, GCS6-8: 40%, GCS-9- 12: 25%
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