Moderate traumatic brain injury - the acute phase

Abstract

Background and aim: Patients with moderate traumatic brain injury (TBI) have variability in the acute phase course and long-term outcome. Research is limited and often inconclusive. The aim was to study intensive care treatment and deviations from treatment goals in selected physiological variables in moderate TBI. Deviations in the acute phase were based on guidelines for severe TBI patients, and relation to one-year outcome was studied.

Material and methods: During a 5-year period (2004-09), 119 adults (age !16 years) with moderate TBI according to the Head Injury Severity Scale were admitted to St.Olavs Hospital. Injury related and outcome data were collected prospectively and deviations in physiological variables (hypotension, hypoxia, hyperthermia, hyponatremia, hyperglycaemia and anaemia) during the first three days after injury were collected retrospectively. One-year outcome was measured as Glasgow Outcome Scale Extended (GOSE) score.

Results: 52% of the patients stayed at Intensive Care Units (ICU) for at least three days after the TBI. Patients in the ICU group had more frequent intra- and extracranial injuries and higher incidence of subdural haematoma, but the same rate of surgery for intracranial mass lesions as the non-ICU group. 82% of all patients experienced at least one episode of deviation. The most frequently registered deviation was anaemia (30%), whereas hyperglycaemia was the deviation observed in the highest number of patients (53%). In the ICU group, deviation in serum sodium was seen in significantly more patients with disability at one year post-injury than in patients with no disability (p=0.013).

Conclusion: More than half of the moderate TBI patients needed ICU stay all of the first three days, and the high percentage of intra- and extracranial injuries contributed to this. Deviations in selected physiological variables were present, however, hyponatremia was the only deviation associated with disability.