Neuroworsening in the Emergency Department Is a Predictor of Traumatic Brain Injury Intervention and Outcome: A TRACK-TBI Pilot Study.
Document Type
Article
Abstract
INTRODUCTION: Neuroworsening may be a sign of progressive brain injury and is a factor for treatment of traumatic brain injury (TBI) in intensive care settings. The implications of neuroworsening for clinical management and long-term sequelae of TBI in the emergency department (ED) require characterization.
METHODS: Adult TBI subjects from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot Study with ED admission and disposition Glasgow Coma Scale (GCS) scores were extracted. All patients received head computed tomography (CT) scan(vs. ED admission). Clinical and CT characteristics, neurosurgical intervention, in-hospital mortality, and 3- and 6-month Glasgow Outcome Scale-Extended (GOS-E) scores were compared by neuroworsening status. Multivariable regressions were performed for neurosurgical intervention and unfavorable outcome (GOS-E ≤ 3). Multivariable odds ratios (mOR) with [95% confidence intervals] were reported.
RESULTS: In 481 subjects, 91.1% had ED admission GCS 13-15 and 3.3% had neuroworsening. All neuroworsening subjects were admitted to intensive care unit (vs. non-neuroworsening: 26.2%) and were CT-positive for structural injury (vs. 45.4%). Neuroworsening was associated with subdural (75.0%/22.2%), subarachnoid (81.3%/31.2%), and intraventricular hemorrhage (18.8%/2.2%), contusion (68.8%/20.4%), midline shift (50.0%/2.6%), cisternal compression (56.3%/5.6%), and cerebral edema (68.8%/12.3%; all
CONCLUSIONS: Neuroworsening in the ED is an early indicator of TBI severity, and a predictor of neurosurgical intervention and unfavorable outcome. Clinicians must be vigilant in detecting neuroworsening, as affected patients are at increased risk for poor outcomes and may benefit from immediate therapeutic interventions.
Publication Date
3-3-2023
Publication Title
J Clin Med
ISSN
2077-0383
Volume
12
Issue
5
PubMed ID
36902811
Digital Object Identifier (DOI)
10.3390/jcm12052024
Recommended Citation
Yue, John K; Krishnan, Nishanth; Kanter, John H; Deng, Hansen; Okonkwo, David O; Puccio, Ava M; Madhok, Debbie Y; Belton, Patrick J; Lindquist, Britta E; Satris, Gabriela G; Lee, Young M; Umbach, Gray; Duhaime, Ann-Christine; Mukherjee, Pratik; Yuh, Esther L; Valadka, Alex B; DiGiorgio, Anthony M; Tarapore, Phiroz E; Huang, Michael C; and Manley, Geoffrey T, "Neuroworsening in the Emergency Department Is a Predictor of Traumatic Brain Injury Intervention and Outcome: A TRACK-TBI Pilot Study." (2023). Neurology. 1433.
https://scholar.barrowneuro.org/neurology/1433