The impact of body mass index on severity, patterns and outcomes after traumatic brain injuries caused by low level falls.

PURPOSE: Low level falls are a common cause of traumatic brain injuries (TBI) and are associated with significant mortality and disability. The aim of this study was to analyse whether BMI, height and weight of patients were related to severity, patterns and outcomes of TBI caused by low level falls. METHODS: Data on patients with TBI where cause of injury was a low level fall (fall < 3 m) with known body mass index (BMI) (N = 683) were analysed. Patients were categorized into underweight, normal, pre-obese and obese based on BMI and demographic characteristics, injury severity, patterns and outcomes were compared. In addition, physiological status, comorbidities and length of hospitalization were analysed in a subset of patients where this information was available. RESULTS: The median BMI was 25.6. About 1/10 of patients were obese. The mean age and proportion of male sex of patients was increasing with increasing BMI. The patients in all BMI groups were of similar injury severity and neurological status. There was also no difference in mortality and functional outcome based on patient's BMI. Obese and pre-obese patients required longer stay at ICU and in hospital. CONCLUSION: We found no associations between BMI and severity or outcome of TBI caused by low level falls. More detailed data and further studies are needed to fully elucidate these complex relationships.

Timing and duration of intracranial hypertension versus outcomes after severe traumatic brain injury.

BACKGROUND: The goal of this paper was to investigate the association between patterns of intracranial hypertension (IH) and outcomes, to describe the treatment of patients with different patterns of IH, and to examine whether IH is an independent predictor of mortality and unfavourable outcome, respectively. METHODS: A retrospective analysis of data collected prospectively in 9 central European centers is presented. 204 patients with severe TBI who had intracranial pressure (ICP) monitoring were coded as having either early (within first 2 days), late (after first 2 days), or no IH. IH was defined as >60 min of ICP >20 mmHg/day. The total number of hours/day of IH was recorded. Treatment was followed closely for the first 10 days using the therapy intensity level (TIL) score. Associations between types of IH and demographic factors, trauma severity, or treatment factors as well as outcomes were analysed. RESULTS: Patients in the early IH group were the most severely injured. They had the highest TIL levels, had the highest mortality (48%) and the highest rate of unfavourable outcome (65%) followed by the late IH group (20% and 57%) and the no IH group (23% and 36%). Duration of IH correlated significantly with hospital mortality. IH was an independent predictor of mortality and unfavourable outcome after adjusting for age, Glasgow Coma Scale score, and Abbreviated Injury Score "head". CONCLUSION: Intracranial hypertension with early onset is independently associated with significantly worse outcome in patients with severe TBI. The total duration of IH shows a significant correlation to mortality.

Glasgow Coma Scale score at intensive care unit discharge predicts the 1-year outcome of patients with severe traumatic brain injury.

OBJECTIVE: To analyse the association between the Glasgow Coma Scale (GCS) score at intensive care unit (ICU) discharge and the 1-year outcome of patients with severe traumatic brain injury (TBI). DESIGN: Retrospective analysis of prospectively collected observational data. PATIENTS: Between 01/2001 and 12/2005, 13 European centres enrolled 1,172 patients with severe TBI. Data on accident, treatment and outcomes were collected. According to the GCS score at ICU discharge, survivors were classified into four groups: GCS scores 3-6, 7-9, 10-12 and 13-15. Using the Glasgow Outcome Scale (GOS), 1-year outcomes were classified as "favourable" (scores 5, 4) or "unfavourable" (scores <4). Factors that may have contributed to outcomes were compared between groups and for favourable versus unfavourable outcomes within each group. MAIN RESULTS: Of the 538 patients analysed, 308 (57 %) had GCS scores 13-15, 101 (19 %) had scores 10-12, 46 (9 %) had scores 7-9 and 83 (15 %) had scores 3-6 at ICU discharge. Factors significantly associated with these GCS scores included age, severity of trauma, neurological status (GCS, pupils) at admission and patency of the basal cisterns on the first computed tomography (CT) scan. Favourable outcome was achieved in 74 % of all patients; the rates were significantly different between GCS groups (93, 83, 37 and 10 %, respectively). Within each of the GCS groups, significant differences regarding age and trauma severity were found between patients with favourable versus unfavourable outcomes; neurological status at admission and CT findings were not relevant. CONCLUSION: The GCS score at ICU discharge is a good predictor of 1-year outcome. Patients with a GCS score <10 at ICU discharge have a poor chance of favourable outcome.

One-year outcome and course of recovery after severe traumatic brain injury.

GOAL: To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma. METHODS: Between January 2001 and December 2005, 13 European centres enrolled 1,172 patients with severe TBI defined as Glasgow Coma Scale (GCS) score < 9. Demographic data, trauma severity, results of computed tomography (CT) scans, data on status, treatment and outcome were recorded. The five-level Glasgow Outcome Scale (GOS) score was used to classify patients as having a "favourable" (GOS scores 5 and 4) or an "unfavourable outcome" (GOS scores 3, 2 and 1). RESULTS AND CONCLUSIONS: Of the 1,172 patients, 37% died in the intensive care unit (ICU) and 8.5% died after ICU discharge. At 12 months after trauma, almost half of the outcomes (46.6%) were classified as "favourable" (33% "good recovery", 13.6% "moderate disability") and 7.9% were classified as "unfavourable" (6.1% "severe disability", 1.8% "vegetative status"). As in previous studies, long-term outcomes were influenced by age, severity of trauma, first GCS score, pupillary status and CT findings (e.g. subdural haematoma and closed basal cistern on the first CT scan). Patients with "good recovery" had a high likelihood to remain in that category (91%). Patients with "moderate disability" had a 50% chance to improve to "good recovery". Patients with "severe disability" had a 40% chance to improve and had a 4% chance of death. Patients with "vegetative status" were more likely to die (42%) than to improve (31%). Changes were more likely to occur during the first than during the second half-year after trauma.