Page 49 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Decision-making in very severe traumatic brain injury
Surgical intervention.
Evacuation ASDH: 72 Evacuation ASDH+DC:12 Surgery EDH: 5
Emergent hematoma evacuation: 53 Pre-operative medical therapy -> Aggressive: 13.2%, Reinforced: 45.3%
ICP: 80%, Craniotomy: 8%, Craniectomy: 79% -Unilateral 65% -Bilateral: 14%
Surgical intervention.
Surgery: 478 <4h: 92
Surgery: GCS3: 55
GCS4: 15
ICP monitoring: GCS3: 36 GCS4: 5
Surgery: 62.5% -Craniotomy:10 -DC: 60
GCS3-5: 25 surgery
DC:
No focal lesion:11 Focal lesion+ brain oedema: 33
Hematoma evacuation: 67 Second craniotomy: 5
Outcome measure
Mortality/ GOS (6M).
LTFU: 7.4%
GOS (1Y)
Mortality/ GOS (6M, 12M, 24M)
Outcome measure
Mortality(6M)/ GOS(6M)
Mortality/ GOS(12M)
Mortality (6M)/ favorable (6M)
Mortality/ GOS (ICU/hospital discharge, 12- 102M)
Mortality (6M)/ GOS (1M/6M)
Results
Overall mortality: 49.2% 2 Good functional outcome (GOS1+2): 13.2%
Mortality: BFDP: 79.9%, BRP: 23.5%, evacuation ASDH: 48.3%,
ASDH + DC: 50%, EDH 20%
Outcome survivors (N=96): GOS1: 22%, GOS2: 8.5%, GOS3: 42.7%, GOS4: 26.8%.
Not operated (N=62): Mortality: 100%
Surgery: Mortality: 75.5%, GOS2: 7.5%, GOS3: 13.2%, GOS4: 1.9%, GOS5: 1.9%.
Mortality initial admission: 5.8%
Including delayed mortality (24M): 7.3%
Functional independence (GOS≥4) at 24M: Overall: 68% GCS3-5: 32% GCS6-8: 63% GCS9-11: 74% GCS12-15: 100% GCS3-5: Significant improvement at 2 years from discharge
Results
Overall mortality: 71% Unfavorable (GOS1-3): 87% Mortality: Surgery: 62%. No surgery: 81% (P<0.001) Unfavorable: Surgery: 82%. No surgery: 93% (P<0.001) Surgical group: GCS3-5: GOS1: 87%. GOS1-3: 96%, GCS6-15: GOS1: 57%, GOS1-3: 79%, both (P<0.001)
ICU-Mortality:76%.
ICU-Outcome: 11% favorable (GOS4-5) Mortality(12M): 80%.
Outcome (12M): 11% favorable.
All Mortality: 53.6%, Favorable (GOS4-5): 68.8%, Mortality: GCS≤5: 77.5%, GCS>5: 40%, Favorable: GCS≤5: 5%, GCS>5: 46%
Mortality (surgery): 32.9%, favorable: 47.1%
Mortality (conservative): 88.1%, favorable: 4.8%
Overall mortality: ICU 48%, Hospital 57%, 1Y and last follow
up: 77%. Bad outcome (GOS1-3): Hospital discharge and 1Y: 82%. Mortality: GCS3-5: 100%
Good outcome (GOS4-5): GCS6-8=20%, GCS>8 = 50%.
Overall mortality (1M): 55.1%, (6M): 67.2%
Mortality (6M): GCS3–4: 82.4%, GCS14-15: 14.3% Functional recovery (6M): GCS3–4: 5.9%, GCS14-15: 42.9%
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