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Predictors of mortality in patients with isolated severe traumatic brain injury

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Summary

Background

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Many prognostic models predicting mortality in patients with TBI were developed, which also include patients with mild or moderate TBI and patients who suffered major extracranial injuries.

Methods

From a prospective database, we conducted a retrospective medical chart review covering the period between January 2000 and December 2012 of patients with isolated severe TBI (Abbreviated Injury Score for head, AISH ≥ 3) without extracranial injuries, who were intubated in the field using the rapid sequence intubation method and were of age 16 or more. Prehospital vital signs, Injury Severity Score (ISS) and laboratory tests were compared in two study groups: survivors (n = 25) and non-survivors (n = 27). Selected variables identified during univariate analysis (p < 0.1) were then subjected to multivariate analysis logistic regression model.

Results

Univariate analysis showed that in-hospital mortality was statistically significantly associated with male sex (p = 0.040), ISS (p = 0.005) and mydriasis (p = 0.012). For predicting mortality, area under the curve (AUC) was calculated: for ISS 0.76 (95 % confidence interval, CI; 0.63–0.90; p < 0.001) and for initial Glasgow Coma Scale (GCS) 0.64 (95 % CI, 0.49–0.80, p = 0.079). In the multivariate analysis, ISS (odds ratio, OR; 1.19, 95 % CI, 1.06–1.35; p = 0.004) and mydriasis (OR, 5.73; 95 % CI, 1.06–30.88; p = 0.042) were identified as independent risk factors for in-hospital mortality. The AUC for the regression model was 0.83 (95 % CI, 0.71–0.94; p < 0.001).

Conclusions

In prehospital intubated patients with isolated severe TBI only ISS and mydriasis were found to be independent predictors of in-hospital mortality.

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Authors and Affiliations

  1. Center for Emergency Medicine, Community Health Center Maribor, Prehospital Unit, Ulica talcev 9, 2000, Maribor, Slovenia

    Matej Strnad MD, PhD, Vesna Borovnik Lesjak MD & Vitka Vujanović MD

  2. Medical Faculty, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia

    Matej Strnad MD, PhD & Miljenko Križmarić PhD

  3. Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000, Maribor, Slovenia

    Miljenko Križmarić PhD

Authors
  1. Matej Strnad MD, PhD
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  2. Vesna Borovnik Lesjak MD
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  3. Vitka Vujanović MD
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  4. Miljenko Križmarić PhD
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Corresponding author

Correspondence to Matej Strnad MD, PhD.

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Conflict of interest

M. Strnad, V. Borovnik Lesjak, V. Vujanović, and M. Križmarić declare that there is no conflict of interest regarding the publication of this paper.

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Strnad, M., Borovnik Lesjak, V., Vujanović, V. et al. Predictors of mortality in patients with isolated severe traumatic brain injury. Wien Klin Wochenschr 129, 110–114 (2017). https://doi.org/10.1007/s00508-016-0974-0

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  • DOI: https://doi.org/10.1007/s00508-016-0974-0

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