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Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

BACKGROUND: Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome. OBJECTIVE: Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome...

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Autores principales: Godbolt, Alison K, Stenberg, Maud, Jakobsson, Jan, Sorjonen, Kimmo, Krakau, Karolina, Stålnacke, Britt-Marie, Nygren DeBoussard, Catharina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420979/
https://www.ncbi.nlm.nih.gov/pubmed/25941181
http://dx.doi.org/10.1136/bmjopen-2014-007208
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author Godbolt, Alison K
Stenberg, Maud
Jakobsson, Jan
Sorjonen, Kimmo
Krakau, Karolina
Stålnacke, Britt-Marie
Nygren DeBoussard, Catharina
author_facet Godbolt, Alison K
Stenberg, Maud
Jakobsson, Jan
Sorjonen, Kimmo
Krakau, Karolina
Stålnacke, Britt-Marie
Nygren DeBoussard, Catharina
author_sort Godbolt, Alison K
collection PubMed
description BACKGROUND: Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome. OBJECTIVE: Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives. SETTING: Prospective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland. PARTICIPANTS AND ASSESSMENTS: Patients aged 18–65 years with S-TBI and acute Glasgow Coma Scale 3–8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out. OUTCOME MEASURE: Glasgow Outcome Scale Extended. RESULTS: 68 patients had ≥1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model. CONCLUSIONS: Subacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity.
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spelling pubmed-44209792015-05-13 Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome Godbolt, Alison K Stenberg, Maud Jakobsson, Jan Sorjonen, Kimmo Krakau, Karolina Stålnacke, Britt-Marie Nygren DeBoussard, Catharina BMJ Open Rehabilitation Medicine BACKGROUND: Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome. OBJECTIVE: Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives. SETTING: Prospective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland. PARTICIPANTS AND ASSESSMENTS: Patients aged 18–65 years with S-TBI and acute Glasgow Coma Scale 3–8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out. OUTCOME MEASURE: Glasgow Outcome Scale Extended. RESULTS: 68 patients had ≥1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model. CONCLUSIONS: Subacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity. BMJ Publishing Group 2015-05-02 /pmc/articles/PMC4420979/ /pubmed/25941181 http://dx.doi.org/10.1136/bmjopen-2014-007208 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Rehabilitation Medicine
Godbolt, Alison K
Stenberg, Maud
Jakobsson, Jan
Sorjonen, Kimmo
Krakau, Karolina
Stålnacke, Britt-Marie
Nygren DeBoussard, Catharina
Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title_full Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title_fullStr Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title_full_unstemmed Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title_short Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
title_sort subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome
topic Rehabilitation Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420979/
https://www.ncbi.nlm.nih.gov/pubmed/25941181
http://dx.doi.org/10.1136/bmjopen-2014-007208
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