Publication
Title
Prognostic value of major extracranial injury in traumatic brain injury : an individual patient data meta-analysis in 39 274 patients
Author
Institution/Organisation
International Mission on Prognosis and Clinical Trial Design in TBI (IMPACT) Study Group
Corticosteroid Randomization After Significant Head Injury (CRASH) Trial Collaborators
Trauma Audit and Research Network
Abstract
BACKGROUND: Major extracranial injury (MEI) is common in traumatic brain injury (TBI) patients, but the effect on outcome is controversial. OBJECTIVE: To assess the prognostic value of MEI on mortality after TBI in an individual patient data meta-analysis of 3 observational TBI studies (International Mission on Prognosis and Clinical Trial Design in TBI [IMPACT]), a randomized controlled trial (Corticosteroid Randomization After Significant Head Injury [CRASH]), and a trauma registry (Trauma Audit and Research Network [TARN]). METHODS: MEI (extracranial injury with an Abbreviated Injury Scale >= 3 or requiring hospital admission) was related to mortality with logistic regression analysis, adjusted for age, Glasgow Coma Scale motor score, and pupil reactivity and stratified by TBI severity. We pooled odds ratios (ORs) with random-effects meta-analysis. RESULTS: We included 39 274 patients. Mortality was 25%, and 32% had MEI. MEI was a strong predictor for mortality in TARN, with adjusted odds ratios of 2.81 (95% confidence interval [CI], 2.44-3.23) in mild, 2.18 (95% CI, 1.80-2.65) in moderate, and 2.14 (95% CI, 1.95-2.35) in severe TBI patients. The prognostic effect was smaller in IMPACT and CRASH, with pooled adjusted odds ratios of 2.14 (95% CI, 0.93-4.91) in mild, 1.46 (95% CI, 1.14-1.85) in moderate, and 1.18 (95% CI, 1.03-1.55) in severe TBI. When patients who died within 6 hours after injury were excluded from TARN, the effect of MEI was comparable with IMPACT and CRASH. CONCLUSION: MEI is an important prognostic factor for mortality in TBI patients. However, the effect varies by population, which explains the controversy in the literature. The strength of the effect is smaller in patients with more severe brain injury and depends on time of inclusion in a study.
Language
English
Source (journal)
Neurosurgery. - Baltimore, Md, 1977, currens
Publication
Baltimore, Md : 2012
ISSN
0148-396X
1524-4040 [online]
Volume/pages
70:4(2012), p. 811-818
ISI
000301934000028
Full text (Publisher's DOI)
Full text (publisher's version - intranet only)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identification
Creation 14.05.2012
Last edited 03.12.2017
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