Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

Silva, Thiago Henrique da; Massetti, Thais; Silva, Talita Dias da; Paiva, Laercio da Silva; Papa, Denise Cardoso Ribeiro; Monteiro, Carlos Bandeira de Mello; Caromano, Fatima Aparecida; Voos, Mariana Callil; Silva, Lucas Del Sarto

doi:10.1590/1809-2950/17019225012018

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ORIGINAL RESEARCH • Fisioter. Pesqui. 25 (1) • Mar 2018 • https://doi.org/10.1590/1809-2950/17019225012018 copy

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

Influência da gravidade do traumatismo cranioencefálico na admissão hospitalar na evolução clínica

Influencia de la gravedad del traumatismo craneoencefálico en la admisión hospitalaria en la evolución clínica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

Keywords
Craniocerebral Trauma/mortality; Artificial Respiration; Bronchopneumonia; Tracheostomy

Variables	Absolute number	%
Gender
Male	60	89,5
Female	7	10,5
Traumatic Brain Injury severity
Mild	36	53,7
Moderate	14	20,9
Severe	17	25,4
Treatment
Conservative	51	76,1
Surgical	16	23,9
Pneumonia
Yes	23	34,3
No	44	65,7
Tracheostomy
Yes	19	28,4
No	48	71,6
Death
Yes	10	14,9
No	57	85,1
Invasive mechanical ventilation
10 days	8	25,0
11 to 20 days	13	40,6
21 to 30 days	4	12,5
Over 30 days	7	21,9
Time of hospital stay
10 days	28	41,8
11 to 20 days	6	9,0
21 to 30 days	11	16,4
Over 30 days	22	32,8
	Mean	Standard deviation
Age (years)	35,5	19,2

Variables			Chisquare test (p value)
	Treatment
	Conservative	Surgical
Severity	n (%)
Mild	32 (88,9)	4 (11,1)
Moderate	10 (71,4)	4 (28,6)	0,015
Severe	9 (52,9)	8 (47,1)
	Complications from pneumonia
	Yes	No
Severity	n (%)
Mild	8 (22,2)	28 (77,8)
Moderate	4 (28,6)	10 (71,4)	0,009
Severe	11 (64,7)	6 (35,3)
	Tracheostomy
	Yes	No
Severity	n (%)
Mild	3 (8,3)	33 (91,7)
Moderate	6 (42,9)	8 (57,1)	0,001
Severe	10 (58,8)	7 (41,2)
	Deaths
	Yes	No
Severity	n (%)
Mild	3 (8,3)	33 (91,7)
Moderate	2 (14,3)	12 (85,7)	0,132
Severe	5 (29,4)	12 (70,6)

Variables	Invasive mechanical ventilation time				p*
Variables	10 days	11 to 20 days	21 to 30 days	Over 30 days
Severity	n (%)
Mild	3 (37,5)	1 (12,5)	1 (12,5)	3 (37,5)
Moderate	2 (28,6)	3 (42,9)	1 (14,3)	1 (14,3)	0,630
Severe	3 (17,6)	9 (52,9)	2 (11,8)	3 (17,6)
Variables	Time of hospital stay				p*
Variables	10 days	11 to 20 days	21 to 30 days	Over 30 days
Severity	n (%)
Mild	23(63,9)	3 (8,3)	4 (11,1)	6 (16,7)
Moderate	4 (28,6)	2 (14,3)	4 (28,6)	4 (28,6)	0,001
Severe	1 (5,9)	1 (5,9)	3 (17,6)	12 (70,6)

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E-mail: revfisio@usp.br

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[1] Corresponding address: Thiago Henrique da Silva - Universidade de São Paulo - Cipotânea Street, 51, Cidade Universitária - São Paulo (SP), Brazil - Zip Code: 05360-160 - E-mail: thi1822@gmail.com