Severe traumatic brain injury and acute kidney injury patients: factors associated with in-hospital mortality and unfavorable outcomes.

OBJECTIVE: The purpose of this study was to identify the occurrence of AKI, and factors associated with in-hospital mortality and unfavorable outcomes in patients with severe traumatic brain injury (TBI) and acute kidney injury (AKI) severity. METHOD: A retrospective cohort study which analyzed data with severe TBI between 2013 and 2017. We examined demographic and clinical information, and outcome by in-hospital mortality, and the Glasgow Outcome Scale six months after TBI. We associated factors to in-hospital mortality and unfavorable outcome in severe TBI and AKI with an association test. RESULTS: A total of 219 patients were selected, 39.3% had an AKI, and several factors associated with AKI occurrence after severe TBI. Stage 2 or 3 of AKI (OR 12.489; 95% CI = 4.45-37.94) were independent risk for both outcomes in multivariable models, severity injury by the New Trauma Injury Severity Score (OR 0.97; 95% CI = 0.96-0.99) for mortality, and the New Injury Severity Score (OR1.07; 95% CI = 1.04-1.10) and Trauma and Injury Severity Score (OR = 0.98; 95% CI = 0.965-0.997) for unfavorable outcome. CONCLUSION: The findings of our study confirmed that AKI severity and severity of injury was also related to increased mortality and unfavorable outcome after severe TBI.

Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study.

OBJECTIVE: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. METHODOLOGY: This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS: The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. CONCLUSIONS: Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.

Prognostic Models in Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis.

This review aimed to analyze the results of investigations that performed external validation or that compared prognostic models to identify the models and their variations that showed the best performance in predicting mortality, survival, and unfavorable outcome after severe traumatic brain injury. Pubmed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, TROVE, and Open Grey databases were searched. A total of 1616 studies were identified and screened, and 15 studies were subsequently included for analysis after applying the selection criteria. The Corticosteroid Randomization After Significant Head Injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) models were the most externally validated among studies of severe traumatic brain injury. The results of the review showed that most publications encountered an area under the curve ≥ 0.70. The area under the curve meta-analysis showed similarity between the CRASH and IMPACT models and their variations for predicting mortality and unfavorable outcomes. Calibration results showed that the variations of CRASH and IMPACT models demonstrated adequate calibration in most studies for both outcomes, but without a clear indication of uncertainties in the evaluations of these models. Based on the results of this meta-analysis, the choice of prognostic models for clinical application may depend on the availability of predictors, characteristics of the population, and trauma care services.

Behavioral Changes and Associated Factors After Diffuse Axonal Injury.

Diffuse axonal injury (DAI) is a frequent injury after traumatic brain injury (TBI), which causes cognitive and behavioral symptoms. Behavioral changes after DAI affect the patients' quality of life, in addition to causing great damage to their family and society. This study aimed to analyze the behavioral changes of patients with DAI according to family members and to identify the associated factors. This study included patients with DAI, aged between 18 and 60 years, who presented to a referral hospital for traumatic injuries. A prospective cohort study was conducted with 2 evaluations of family members at 3, 6, and 12 months posttrauma. Behavioral changes were evaluated using a questionnaire designed to identify changes according to the perception of family members. The mixed-effects model was applied to identify significant behavioral changes, the effect of time on these changes, and the association between sociodemographic variables, DAI severity, and behavioral changes. Anxiety, dependency, depression, irritability, memory, and mood swings were significantly different (p ≤ .05) before and after trauma. An analysis of the evolution of these behaviors showed that the changes persisted with the same intensity up to 12 months posttrauma. There was an association between depression and income, age and irritability, and DAI severity and dependency. Unfavorable behavioral changes were frequent consequences of DAI, and no improvement in these changes was noted up to 12 months after the injury. Income, age, and DAI severity were related to behavioral changes.

Recovery of Patients with Pure Diffuse Axonal Injury Who Remained in a Coma for 6 Hours or More.

BACKGROUND: Diffuse axonal injury (DAI) is a traumatic brain injury and one of the most common causes of unfavorable outcome and death. The aim of this study was to investigate the recovery of patients with pure DAI who remained in a coma for 6 hours or longer after brain injury. METHODS: This was a follow-up study of 75 patients diagnosed with pure DAI, aged 18-60 years, with a Glasgow Coma Scale score ≤8 at hospital admission. Patient data were collected at hospital admission, hospital discharge, and 3 and 6 months after DAI. Recovery was assessed by score changes in the Katz Index of Independence in Activities of Daily Living and Extended Glasgow Outcome Scale. RESULTS: The percentage of patients in a coma for 6-24 hours, >24 hours without brainstem signs, and >24 hours with brainstem signs was 42.7%, 20%, and 37.3%, respectively. The 6-month mortality rate was 32.0%, and the mean Extended Glasgow Outcome Scale score among survivors decreased from 3.8 at discharge (SD = 1.2) to 2.1 at 3 months (SD = 1.6) and 1.2 at 6 months (SD = 1.6). The mean Katz Index of Independence in Activities of Daily Living scores were 8.5 (SD = 5.5), 3.5 (SD = 5.8), and 1.8 (SD = 4.5) at discharge and 3 and 6 months after trauma, respectively. Statistically significant differences were observed among the 3 evaluation periods. CONCLUSIONS: Mortality was high among patients with DAI, but almost all survivors had favorable outcomes at 6 months. Functional improvement was more pronounced in the first 3 months.

Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors.

Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables - DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value - had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence.

Quality of life of victims of traumatic brain injury six months after the trauma.

OBJECTIVE: to describe the quality of life of victims of traumatic brain injury six months after the event and to show the relationship between the results observed and the clinical, sociodemographic and return to productivity data. METHOD: data were analyzed from 47 victims assisted in a trauma reference hospital in the municipality of Aracaju and monitored in an outpatient neurosurgery clinic. The data were obtained through analysis of the patient records and structured interviews, with the application of the World Health Organization Quality of Life, brief version, questionnaire. RESULTS: the victims presented positive perceptions of their quality of life, and the physical domain presented the highest mean value (68.4±22.9). Among the sociodemographic characteristics, a statistically significant correlation was found between marital status and the psychological domain. However, the return to productivity was related to all the domains. CONCLUSION: the return to productivity was an important factor for the quality of life of the victims of traumatic brain injury and should direct the public policies in promoting the health of these victims.

[An epidemiological survey on motorcycle accident victims assisted at a reference trauma center of Sergipe]. / Levantamento epidemiológico dos acidentes motociclísticos atendidos em um Centro de Referência ao Trauma de Sergipe.

The trauma caused by motorcycle accidents affects a large number of victims and is a serious public health problem in Brazil. This documental study was performed with a quantitative approach with the objective to raise epidemiological data from 554 motorcycle accident victims assisted in September and October 2006 in a referral center for trauma of Sergipe. The result analysis shows a predominance of men (82.7%) with mean age of 27.78 years, who were admitted during the night shift (45.9%), Sunday (27.3%), whose injuries were abrasions (n=169) on the head, face and neck. The victims stayed in the hospital for up to 12 hours (76%) and were discharged. Of the registered cases, 14.6% were suspected of having consumed alcohol and 19.3% were not wearing a helmet during the accident.