Prognostic Value of Major Extracranial Injury in Traumatic Brain Injury: An Individual Patient Data Meta-analysis in 39,274 Patients.


van Leeuwen, N; Lingsma, HF; Perel, P; Lecky, F; Roozenbeek, B; Lu, J; Shakur, H; Weir, J; Steyerberg, EW; Maas, AI; International Mission on Prognosis and Clinical Trial Design in, ; Corticosteroid Randomization After Significant Head Injury Trial, ; Trauma Audit and Research Network, ; (2012) Prognostic Value of Major Extracranial Injury in Traumatic Brain Injury: An Individual Patient Data Meta-analysis in 39,274 Patients. Neurosurgery, 70 (4). 811-8; discussion 818. ISSN 0148-396X DOI: https://doi.org/10.1227/NEU.0b013e318235d640

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Abstract

BACKGROUND: Major extracranial injury (MEI) is common in traumatic brain injury (TBI) patients, but the effect on outcome is controversial.<br/> 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]).<br/> 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.<br/> 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.<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 21904253
Web of Science ID: 301934000028
URI: http://researchonline.lshtm.ac.uk/id/eprint/185

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