Early Prognosis of Severe Traumatic Brain Injury in an... : Journal of Trauma and Acute Care Surgery (original) (raw)

Original Article

Early Prognosis of Severe Traumatic Brain Injury in an Urban Argentinian Trauma Center

Petroni, Gustavo MD, MCR; Quaglino, Marta PhD; Lujan, Silvia MD; Kovalevski, Leandro MSc, MCR; Rondina, Carlos MD; Videtta, Walter MD; Carney, Nancy PhD; Temkin, Nancy PhD; Chesnut, Randall MD, FCCM, FACS

From the Intensive Care Unit (G.P., S.L., C.R.), Hospital Emergencias Dr. Clemente Alvarez, Rosario, Santa Fe, Argentina; School of Economics and Statistics (M.Q., L.K.), Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina; Intensive Care Unit (W.V.), Hospital Nacional Prof. Dr. Alejandro Posadas, Buenos Aires, Argentina; Department of Neurological Surgery (N.T., R.C.), University of Washington, Seattle, Washington; and Department of Medical Informatics and Clinical Epidemiology (N.C.), Oregon Health & Science University, Portland, Oregon.

Submitted for publication June 16, 2009.

Accepted for publication November 9, 2009.

Supported by U.S. Department of Education, National Institute on Disability and Rehabilitation Research grant H133G 000154, Fogarty International Center of the National Institutes of Health (NIH) grant 5 D43 TW007566, and National Institute of Neurological Disorders and Stroke and Fogarty International Center of the NIH grant 1 R01 NS058302.

The authors are solely responsible for the content of the article, and the opinions do not necessarily represent the views of any listed funding source.

Address for reprints: Gustavo Petroni, MD, España 1734, 10 floor, Apt 2, Rosario (2000), Santa Fe, Argentina; email: [email protected].

The Journal of Trauma: Injury, Infection, and Critical Care 68(3):p 564-570, March 2010. | DOI: 10.1097/TA.0b013e3181ce1eed

Abstract

Background:

Previous studies indicate that age, Glasgow Coma Scale score (GCS), arterial hypotension, computed tomography (CT) findings, and pupillary reactivity are strong predictors of outcome for patients with severe traumatic brain injury (TBI). However, the predictive validity of these variables has never been rigorously tested in patients from the developing world. The objective of this study was to evaluate the prognostic value of these variables in a resource-limited setting and to test their predictive power by using them to create an outcome model.

Methods:

The study was conducted at Hospital Emergencias “Dr. Clemente Alvarez” in Rosario, Argentina. All patients with severe TBI meeting criteria between August 2000 and February 2003 were included. Outcome at 6 months postinjury was measured by mortality and by the Extended Glasgow Outcome Scale score. Two logistic regression models were created for predicting mortality and outcome.

Results:

Outcome measures were acquired for 100% of the sample (N = 148). There was 58% mortality; 30% had moderate to good recovery, and 12% were severely disabled. The model accurately predicted 83.9% of mortality, and 81.1% of outcome. Because of variation in timing of CT scans, the models were recalculated without the CT variable. The accuracy of prediction was 79.7% and 79% for mortality and Extended Glasgow Outcome Scale, respectively.

Conclusions:

This study provides rigorous, prospective data that (1) validates the generalizability of the five World Health Organization/Organization Mondiale de la Santé TBI prognostic predictors outside of the developed world, and (2) provides outcome benchmarks for mortality and morbidity from severe TBI in developing countries.